September 21, 2023

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California awards Medi-Cal contracts to five insurers

California awards Medi-Cal contracts to five insurers

Picture: VioletaStoimenova/Getty Photos

The California Department of Health Care Expert services (DHCS) has joined with five industrial managed care strategies (MCPs) in an arrangement to supply Medi-Cal solutions to Medi-Cal managed care customers in 21 counties throughout the state setting up in January 2024.

The MCPs consist of Blue Cross of California Partnership Strategy, Blue Shield of California Guarantee Well being Plan, Neighborhood Overall health Group Partnership System, Wellbeing Web Neighborhood Answers and Molina Health care of California.

The contracts consist of well being equity and transparency requirements.

DHCS said that its major precedence is to ensure that Medi-Cal members have obtain to wellbeing coverage designs that “offer substantial-good quality and well timed treatment and are targeted on delivering on the state’s transformations that are built to move the health and fitness process to grow to be human being-centered, fairness-targeted, and information-driven.”

What’s THE Impression?

To deliver certainty for customers, suppliers and plans, the point out applied its authority to function instantly with the programs to re-chart the partnership to speed up the implementation of the variations. 

“Together we can get started our collective perform of providing a human being-centered, fairness-concentrated, and info-pushed Medi-Cal application,” DHCS stated. “As section of this agreement, Medi-Cal well being options will be held to new requirements of treatment and bigger accountability.”

These plans, and all other Medi-Cal managed care strategy associates, will operate less than the new MCP contract. 

To assistance handle the social motorists of health the new contracts need partnerships with regional well being departments, regional academic and governmental companies, and other regional applications and expert services, such as social solutions, baby welfare departments and justice departments. This, the company reported, is to assure member care is coordinated and users have accessibility to community-dependent sources, which includes community supports.

THE Much larger Pattern

In October, Blue Shield of California submitted a lawsuit from the state’s Department of Overall health Care Services alleging the section of failing to provide documents detailing designs for how it will contract with for-revenue insurers who look for participation in Medi-Cal.

Blue Protect criticized DHCS for intending to award contracts to countrywide, for-revenue organizations. It also criticized the agency for offering Kaiser Permanente a individual, no-bid Medi-Cal deal, charging that the health program has acquired preferential remedy that allows it to prioritize much healthier Medi-Cal enrollees – leaving sicker people to Blue Protect CA and other well being designs.

The insurance company also took issue with DHCS assigning an worker from its Details Administration Divisions the part of hearing officer in the make a difference.

Proponents of the legislation, signed by California Governor Gavin Newsom over the summer season, stated Kaiser Permanente is nicely-positioned to serve Medi-Cal enrollees. While the legislation isn’t going to point out Kaiser precisely, draft laws did, expressing that Kaiser was the only system that satisfied all the bill’s requirements.

The early laws also asserted that by contracting with Kaiser as an choice health care company program (AHCSP), the state would have oversight of its Medi-Cal involvement, and would not want to take money intended for care and apply them in its place to administrative processes.

The last draft of the legislation does not include language specific to Kaiser Permanente or its involvement in the Medi-Cal software.

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