September 07, 2022

The California Department of Health Services (DHCS) recently announced the results of its first-ever competitive Medi-Cal Managed Care Marketplace, which DHCS says will redefine how care is delivered and which commercial payers will participate in the California program. of Medi-Cal managed care. from 2024.

As part of the bidding process, DHCS announced plans to award contracts to Molina Healthcare, Anthem Blue Cross Partnership Plan, and Health Net to provide Medi-Cal managed care services in California. starting in 2024. The DHCS estimates that approximately 2.3 million managed care members will transition to a new plan as a result of commercial provisioning, with the majority of those in Los Angeles, Kern, Sacramento counties and San Diego.

All statewide Medi-Cal Managed Care Plans (MCPs), including public plans and Kaiser Permanente, will also need to meet the new, enhanced MCP contract requirements when the new contract takes effect Jan. 1. 2024.

As a result of the restructured managed care contract, plans must commit to a series of new requirements that advance health equity and improve population health. Priorities include:

  • Provision of culturally appropriate care and access to providers, and coordination of care across settings and at all levels.
  • All MCPs will need to engage and coordinate with local community partners, invest resources in the community, and publicize their performance and health equity activities.
  • High quality, accessible and comprehensive care in all settings and levels of care.
  • Reduce health disparities and improve health outcomes.
  • Transparency by providing information and ideas to support the choice of plan.

This market only applied to commercial MCPs in 21 counties. Local Initiative Health Plans and County Organized Health Systems were not part of the procurement and did not have to bid during the process. The DHCS also allows 17 counties to modify the type of managed care model offered and has approved a direct contract proposal with Kaiser Permanente in 32 counties, subject to federal approval.

In counties where there are model and/or plan changes, physicians will need to consider contracting with a new plan if they wish to continue seeing Medi-Cal patients beginning in 2024.

Medi-Cal patients also have continuity of care rights that will be fully protected and enforced during the transition. For example, if a patient is currently under the care of a physician for the previous 12 months for treatment of a medical condition, the patient has the right to continue seeing that physician for up to 12 months if certain conditions are fulfilled.

DHCS intends to award 28 contracts to the following commercial MCPs to provide Medi-Cal services in 21 counties:

Expected winners Counties
Molina Health Los Angeles, Riverside, San Bernardino, Sacramento, San Diego
Anthem Blue Cross Partnership Plan Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, KernKings, Madera, Mono, Santa Clara, San Francisco, Sacramento, Tuolumne
health net Amador, Calaveras, Inyo, Mono, San Diego, San Joaquin, Stanislaus, Tulare, Tuolumne

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Plans that were not selected were allowed to appeal the decision. (The list of appeal records can be viewed here.)

The California Medical Association will closely monitor the transition and keep doctors informed as new information becomes available.

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