Ms. Mailer is the Health Plan Sales Manager that works directly with Employment and Human Services to help with the Medi-Cal member's Annual Redetermination Process. Her work and expertise is vitally important to the requirement for continuity of care for our Medi-Cal members who are undergoing the Redetermination Process. Ms. Mailer is the expert who can ensure that these terminated members get reenrolled promptly back into the Health Plan and can then receive much needed medical care. The State of California re-initiated the Annual Medi-Ca; Redetermination Process for Medi-Cal recipients in January 2015. The process was supposed to include auto renewal for our members, as well as retroactive eligibility into the Plan. However, there were some IT glitches in the State system that disenrolles thousands of CCHP members monthly and fails to retroactively reenroll them when they completed the certification process. The State Department of Managed Care specifically asked the Contra Costa Health Plan and other California health plans to work with the County’s’ Employment and Human Services Department (EHSD) to help assist them with the Medi-Cal residents in the counties due to backlogs in processing new Medi-Cal applications and the redetermination of terminated members.
With her valuable knowledge of Medi-Cal eligibility, Ms. Mailer has been working with EHSD in designing reports that will indicate the total number of individuals and/or cases at risk for discontinuance each month as well as advising residents who want to enroll in Medi-Cal. EHSD shared aggregate information with CCHP and Ms. Mailer trains and oversees CCHP marketing employees in working with terminated members and assist EHSD in the reenrollment process. Under the monitoring of Ms. Mailer, the marketing unit makes thousands of calls monthly to residents on the EHSD lists, and assists them in the enrollment process and keeps eligible Medi-Cal members enrolled in CCHP and receiving health care services.
Additionally, CCHP is no longer involved in heavy marketing campaigns, as the vast majority of our membership is mandated Medi-Cal recipients. At this time, we are not allowed by the State to do direct marketing campaigns for Medi-Cal. Therefore, CCHP has decided at this time to not invest more money in rehiring a higher cost full-time Director. A part-time Sales Manager with Wendy Mailer’s special expertise is sufficient to meet the needs of the Health Plan at this time. CCHP also unsuccessfully ran recruitment in 2014 for a Director of Marketing and Public Relations-Exempt. The Department was not able to find the appropriate fit in the candidates interviewed.
At this time, the workload and management need for CCHP's Marketing has been reduced from prior years since we no longer participate in the State Exchange: Covered California or the private health insurance market. The focus now in CCHP is retentionof our Medi-Cal membership.
Health Care is changing and CCHP will continue assisting new Medi-Cal members and in the retention activities for existing members when annual redetermination is delayed .
At this time and for the continuation of a year, Ms. Mailer's role as a consultant on a part-time basis is absolutely critical to CCHP's success in meeting mandated State requirements. The Health plan considers that Ms. Mailer’s assistance with CCHP will be sufficient until the State’s Dual Eligible beneficiaries are later mandated into managed care and then CCHP will reopen and recruit for the Director of Marketing classification to replace Ms Mailer.
Failure to receive Board approval may jeopardize efforts of the Health Services Department to comply with mandated State requirements.