To advance health equity, quality, access, accountability, and transparency, new Medi-Cal Managed Care Plan (MCPs) Contracts will take effect across the state of California starting in January 2024. MCPs play a vital role in CalAIM, which stands for California Advancing and Innovating Medi-Cal, and will prioritize prevention and whole-person care.
Under the new contracts, Blue Cross of California Partnership Plan, known as Anthem, will serve 14 counties, including Fresno and Inyo. Blue Shield of California Promise Health Plan, and CHG Foundation’s Community Health Group Partnership Plan will both be serving San Diego County. Health Net will serve ten counties and will subcontract to Molina County for 50% of its membership. Molina Healthcare of California will serve four counties, and will act as a subcontractor for Health Net in Los Angeles County for 50% of its membership.
A diverse panel of experts spoke about the importance of the new contracts at the 2023 Northern California State of Reform Health Policy Conference. Susan Phillip, deputy director of Health Care Delivery Systems for California’s Department of Health Care Services spoke on the matter.
“By 2024, 99% of Medi-Cal beneficiaries will be on a managed care plan, so managed care is really how we deliver services in California to our Medi-Cal beneficiaries,” Phillip said.
Phillips explained how all MCPs are required to go through rigorous readiness processes, which have been taking place since 2022. The purpose of the readiness review is to ensure plans are prepared to comply with new contract requirements.
One major change focuses on transparency, and requires plans to publicly and routinely report on access, quality, and health equity, said Phillip. She added that plans will be required to post their community investment plans, which show how plans are taking excess revenue and reinserting it into the community.
DHCS states that MCPs and their fully delegated subcontractors with positive net income must allocate five to seven-and-a-half percent of profits to local community efforts that build community infrastructure to support Medi-Cal beneficiaries. Plan partners must also submit a Community Reinvestment Plan and Report which details how the reinvestment activities will benefit communities, and outcomes of the investments. Additional transparency measures include annual surveys related to consumer satisfaction, among others.
Another key provision focuses on local presence and engagement. Phillip said there’s a new section in the contract that requires community engagement with members and families and partnership with local community-based organizations to bring their perspectives into the conversation.
“We’re really working with our plan partners to think through all the different moving pieces, and I say, there’s kind of four different work streams,” Phillip said. “First, there’s a contract deliverable review. There’s guidance, development and vetting. There’s something that we’re calling a go-live assessment, and then there’s a 2024 transition policy.”
Phillip said DHCS is working hard with plan partners on data exchange so plans that are entering or exiting the contract understand who their members are, and can maintain that continuity of care. As part of their communication efforts, DHCS will contact members 90 days, 60 days, and 30 days prior to the transition to provide clear education and communication to members.
The 2024 transition policy guide, which shows what steps plans entering and exiting contracts need to take, is under development; the first chapter of the policy guide, which focuses on the continuity of care, was released several weeks ago, Phillip said, and more chapters will be released in coming weeks.
Rebecca Sullivan, government affairs director for Local Health Plans of California (LHPC), was also a panelist at the conference, and provided input from a local health plan perspective. LHPC operates in 36 of the 58 California counties, and by 2024, she said 51 out of the 58 counties will have a local plan presence.
“For these expansion plans in particular, operational readiness takes on a little bit of a different meaning,” Sullivan said. “It is critical to the success of this transition to grow local connections and relationships with our providers, our counties, and our communities we serve.”
Sullivan mentioned how many of the new requirements in the 2024 Medi-Cal MCP contract will require additional resources, including staff. Existing staff will be asked to take on more workload, and new individuals will need to be hired. Given the healthcare workforce shortages, Sullivan added that hiring additional staff creates time constraints.
“There’s still a lot to be done to understand the policies that are coming out—some of these policy guide documents that are coming out—and we just want to be sure that we’re deliberate in the roll-out so that we don’t disrupt these existing initiatives, and the existing work that’s being done that’s really important,” Sullivan said.
According to DHCS, the new contracts will allow for more culturally competent care, as beneficiaries will receive care and services that take their culture, sexual orientation, gender identity, and preferred languages into account.
Beneficiaries can also expect to receive improved integration of behavioral and physical health as DHCS prioritizes closing the gap between the two, as well as improving access to mental health and substance use disorder services. MCPs will be required to review reports to identify members who are not accessing primary care, which implies that they might not be undergoing screenings or preventative care.
“As a system, we need to ensure that there’s coordination across the system to streamline processes by leveraging existing work that’s being done,” Sullivan said.