California’s Department of Health Care Services (DHCS) was joined by five commercial managed care plans (MCPs) on December 30th to announce new contract agreements concerning the provision of Medi-Cal managed care. The new contracts start in January of 2024 and will span across 21 counties.
DHCS experienced backlash from several health plans over the initial contract announcement last year, including Blue Shield of California, Health Net, Community Health Group Partnership Plan, who filed lawsuits against DHCS after the first ever statewide competitive procurement for commercial Medi-Cal MCPs.
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Through the original procurement, DHCS did not award Blue Shield or Community Health Group a contract in any county, nor did they award Health Net a contract in Los Angeles, Sacramento, or Kern counties. Blue Shield filed lawsuits and alleged that DHCS violated the state public records act by refusing to produce documents on the scoring process, methodology, and communications related to awarding of contracts for 2024.
The new contracts follow months of disputes after DHCS’s original announcement of 2024 managed care contract recipients in August of last year.
The original awardees included:
- Molina Healthcare for Los Angeles, Riverside, San Bernardino, Sacramento, and San Diego counties.
- Anthem Blue Cross Partnership Plan for Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Madera, Mono, Santa Clara, San Francisco, Sacramento, and Tuolumne counties.
- Health Net for Amador, Calaveras, Inyo, Mono, San Diego, San Joaquin, Stanislaus, Tulare, and Tuolumne counties.
“On behalf of Blue Shield of California Promise Health Plan (Blue Shield Promise) and our members, we are honored to continue serving Medi-Cal beneficiaries in San Diego county,” Kristen Cerf, President and CEO of Blue Shield Promise said. “We look forward to working with leaders, and providers in our combined efforts to transform Medi-Cal through California Advancing and Innovating Medi-Cal (CalAIM) and bring access to quality health care to all Californians who need this vital program.”
The MCPs include Blue Cross of California Partnership Plan (“Anthem”), Blue Shield of California Promise Health Plan, CHG Foundation d.b.a. Community Health Group Partnership Plan, Health Net Community Solutions, Inc., and Molina Healthcare of California.
“We are committed to improving the health care delivery and experience for Medi-Cal members by setting a new standard for what person-centered and equity-focused care looks like in the Golden State,” read the announcement. “This agreement will provide certainty for our members, providers, and stakeholders as we work together to embark on fundamental transformation of the Medi-Cal program in 2024.”
The statement also mentioned DHCS’ commitment to pioneering Medicaid transformation across the country and within California. The state’s priority with the new contracts is to ensure Medi-Cal members have access to health insurance plans which provide high quality and timely care, is person centered, equity focused, and data driven.
These MCPs and all other Medi-Cal managed care plan partners will operate under the new MCP contract for Medi-Cal members, according to DHCS. To ensure member care is coordinated and that members have access to community services, the new contracts require partnerships with local health departments, local educational and governmental agencies, and other local programs and services, such as social services, child welfare departments, and justice departments.
Under new contracts Medi-Cal members can expect coordinated access to care; those who need extra assistance will have access to care management based on individual needs, such as having a designated point person, a care manager who can handle referrals, and support communication with providers.
Medi-Cal members can also expect to receive more culturally competent care through care and services that take members’ culture, sexual orientation, gender and gender identity, and preferred language into account.
The 2024 Medi-Cal MCPs and the counties of service include:
- Blue Cross of California Partnership Plan (“Anthem”) to serve Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Madera, Mono, Sacramento, San Francisco, Santa Clara, and Tuolumne counties.
- Blue Shield of California Promise Health Plan will serve San Diego county.
- CHG Foundation d.b.a. Community Health Group Partnership Plan will also serve San Diego county.
- Health Net Community Solutions, Inc., will serve Amador, Calaveras, Inyo, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne, and Los Angeles counties, with a subcontract to Molina for 50% of Los Angeles membership.