California awards Medi-Cal contracts to five insurers

Photo: VioletaStoimenova/Getty Images

The California Department of Health Care Services (DHCS) has joined with five commercial managed care plans (MCPs) in an agreement to deliver Medi-Cal services to Medi-Cal managed care members in 21 counties across the state starting in January 2024.

The MCPs include Blue Cross of California Partnership Plan, Blue Shield of California Promise Health Plan, Community Health Group Partnership Plan, Health Net Community Solutions and Molina Healthcare of California.

The contracts include health equity and transparency requirements.

DHCS said that its top priority is to ensure that Medi-Cal members have access to health insurance plans that "provide high-quality and timely care and are focused on delivering on the state's transformations that are designed to move the health system to become person-centered, equity-focused, and data-driven."

WHAT'S THE IMPACT?

To bring certainty for members, providers and plans, the state used its authority to work directly with the plans to re-chart the partnership to accelerate the implementation of the changes. 

"Together we can begin our collective work of delivering a person-centered, equity-focused, and data-driven Medi-Cal program," DHCS said. "As part of this agreement, Medi-Cal health plans will be held to new standards of care and greater accountability."

These plans, and all other Medi-Cal managed care plan partners, will operate under the new MCP contract. 

To help address the social drivers of health the new contracts require partnerships with local health departments, local educational and governmental agencies, and other local programs and services, including social services, child welfare departments and justice departments. This, the agency said, is to ensure member care is coordinated and members have access to community-based resources, including community supports.

THE LARGER TREND

In October, Blue Shield of California filed a lawsuit against the state's Department of Health Care Services alleging the department of failing to supply documents detailing plans for how it will contract with for-profit insurers who seek participation in Medi-Cal.

Blue Shield criticized DHCS for intending to award contracts to national, for-profit companies. It also criticized the agency for giving Kaiser Permanente a separate, no-bid Medi-Cal contract, charging that the health system has received preferential treatment that allows it to prioritize healthier Medi-Cal enrollees – leaving sicker patients to Blue Shield CA and other health plans.

The insurer also took issue with DHCS assigning an employee from its Information Management Divisions the role of hearing officer in the matter.

Proponents of the law, signed by California Governor Gavin Newsom over the summer, said Kaiser Permanente is well-positioned to serve Medi-Cal enrollees. While the law doesn't mention Kaiser specifically, draft legislation did, saying that Kaiser was the only plan that met all the bill's requirements.

The early legislation also asserted that by contracting with Kaiser as an alternative healthcare service plan (AHCSP), the state would have oversight of its Medi-Cal involvement, and wouldn't need to take funds meant for care and apply them instead to administrative processes.

The final draft of the law does not contain language specific to Kaiser Permanente or its involvement in the Medi-Cal program.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com