September 07, 2022
The California Department of Health Care Services (DHCS) lately introduced the outcomes of its first ever aggressive Medi-Cal managed care procurement, which in keeping with DHCS will redefine how care is delivered and which commercial payors will take part in California’s Medi-Cal managed care program starting in 2024.
Through the aggressive bidding course of, DHCS introduced its intent to award contracts to Molina Healthcare, Anthem Blue Cross Partnership Plan, and Health Net to ship Medi-Cal managed care providers in California starting in 2024. DHCS estimates that roughly 2.3 million managed care members, will transition to a new plan as a outcome of the commercial procurement, with the vast majority of these in Los Angeles, Kern, Sacramento and San Diego counties.
All Medi-Cal managed care plans (MCP) statewide—together with public plans and Kaiser Permanente—may also have to fulfill the new and enhanced MCP contract necessities when the new contract goes into impact on January 1, 2024.
As a results of the restructured managed care contract, plans should decide to a spread of new necessities that advance well being fairness and enhance inhabitants well being. Priorities embody:
- The supply of culturally competent care and entry to suppliers, and coordination of care throughout settings and in any respect ranges.
- All MCPs shall be anticipated to interact and coordinate with local people companions, make investments sources into the group, and make public their efficiency and well being fairness actions.
- High-quality, accessible, and complete care throughout all settings and ranges of care.
- Reducing well being disparities and bettering well being outcomes.
- Transparency by making obtainable information and insights to assist plan selection.
This procurement solely utilized to commercial MCPs in 21 counties. The Local Initiative Health Plans and the County Organized Health Systems weren’t a part of the procurement and didn’t must bid in the course of the course of. DHCS can be permitting 17 counties to alter the kind of managed care mannequin supplied, and accredited a proposed direct contract with Kaiser Permanente in 32 counties, topic to federal approval.
In counties the place there are mannequin and/or plan adjustments, physicians might want to take into account contracting with a new plan in the event that they want to proceed to see Medi-Cal sufferers starting in 2024.
Medi-Cal sufferers even have continuity of care rights that shall be absolutely protected and enforced in the course of the transition. For instance, if a affected person is presently beneath the care of a doctor in the course of the prior 12 months for remedy of a medical situation, the affected person has the precise to proceed seeing that physician for as much as 12 months if sure situations are met.
DHCS intends to award 28 contracts to the next commercial MCPs to ship Medi-Cal providers in 21 counties:
| Intended Awardees | Counties |
| Molina Healthcare | Los Angeles, Riverside, San Bernardino, Sacramento, San Diego |
| Anthem Blue Cross Partnership Plan | Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Madera, Mono, Santa Clara, San Francisco, Sacramento, Tuolumne |
| Health Net | Amador, Calaveras, Inyo, Mono, San Diego, San Joaquin, Stanislaus, Tulare, Tuolumne |
*Bolded textual content signifies incumbent
Plans who weren’t chosen have been allowed to attraction the choice.
The California Medical Association shall be carefully monitoring the transition and will maintain physicians knowledgeable as new information turns into obtainable.
For extra information: