The LA Times reports that many Medi-Cal managed care health plans are facing pressure to improve their operations. The California Department of Health Care Services has started a reprocurement process for all Medi-Cal commercial health plans. This means health plans will need to submit proposals for how they can meet the needs of Medi-Cal members.
Poor care coordination is one of the many shortcomings of Medi-Cal, which covers over a third of the state’s population and nearly 40% of children. Advocates, patients and even the state auditor say Medi-Cal has failed to hold accountable the managed-care health plans that cover almost 12 million of its nearly 14 million enrollees.
To remedy these failings, the state has begun an ambitious contracting process that aims to commit the health plans to better service. The state’s exact strategy is unclear. But it is expected to result in new rules for Medi-Cal managed care. The nine commercial insurers, including giants Health Net, Anthem Blue Cross and Blue Shield of California, will have to bid for new contracts intended to set more rigorous care standards. While their members account for fewer than one-third of managed-care enrollees, the companies have made nearly $3 billion from Medi-Cal since 2014.
The new health plan contracts will start in January 2024. Before then, if you need help accessing care from your Medi-Cal health plan, contact the Health Consumer Alliance for free and confidential help: 888-804‑3536 (TTY 877‑735‑2929).
Download the LA Times Article below.
