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[1] 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.


[1] 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.