CCHA Recommends Medi-Cal Managed Care Improvements
The California Department of Health Care Services is developing a process to re-procure its Medi-Cal managed care contracts across the state. In up to thirty-six counties, managed care plans that are currently covering Medi-Cal enrollees will have to compete successfully for the privilege of continuing to serve this population. Other managed care plans, those that are not currently covering Medi-Cal managed care enrollees, may also submit bids. Plans that are chosen would begin operations under new contracts with the Department in January 2024.
Medi-Cal managed care plans have a mixed track record when it comes to serving California’s children. For example, recent data indicate that only 26 percent of children enrolled in Medi-Cal managed care received a well-child visit within the first 15 months of life, and vaccination rates for children in Medi-Cal managed care have consistently hovered around 70 percent – below the Department’s goal of 80 percent.
The Department has an opportunity to use the Medi-Cal managed care re-procurement process to leverage plan performance relative to children. This can be achieved by (1) selecting plans with a track record of serving children well, (2) strengthening the state’s contract language to improve plan accountable for child health outcomes; and (3) expanding enforcement options to give the Department more tools to address plans that fall short of state standards. In July 2021, CCHA was pleased to join a coalition of children’s advocates in offering recommendations on how the Department could use this bidding process to make such improvements. The full text of the letter can be found below.
 The other 22 counties operate county-organized health systems, which are operated under non-bid contracts with the Department. Some additional counties may switch to become county-organized health systems starting in 2024, but this will require both Department approval and approval from the federal government.