California announces new contracts for Medi-Cal in 2024 following lawsuit – State of Reform

The California Department of Health Care Services (DHCS) joined five commercial managed care plans (MCPs) on December 30 to announce new contract agreements related to the delivery of Medi-Cal managed care. The new contracts start in January 2024 and will cover 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, which filed suit against DHCS after the first statewide competitive procurement for MCPs commercial Medi-Cal.

Get the latest state-specific health care policy information delivered to your inbox.

Through the original procurement, DHCS did not award Blue Shield or Community Health Group a contract in any county, nor did it award Health Net a contract in Los Angeles, Sacramento or Kern counties. Blue Shield filed suit and alleged that DHCS violated the state public records act by refusing to produce documents on the evaluation process, methodology and communications related to the 2024 contract award.

The new contracts follow months of controversy following DHCS’ original announcement of recipients of 2024 managed care contracts in August last year.

Original winners 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 network for Amador, Calaveras, Inyo, Mono, San Diego, San Joaquin, Stanislaus, Tulare and Tuolumne counties.

“On behalf of Blue Shield Promise Health Plan of California (Blue Shield Promise) and our members, we are honored to continue serving Medi-Cal beneficiaries in San Diego County,” said Kristen Cerf, President and CEO. of Blue Shield Promise. “We look forward to working with leaders and providers in our combined efforts to transform Medi-Cal across California, advancing and innovating Medi-Cal (CalAIM) and bringing access to quality health care to all Californians who have need for this vital program.”

MCPs include Blue Cross of California Partnership Plan (“Anthem”), Blue Shield of California Promise Health Plan, CHG Foundation 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-centered care looks like in the Golden State,” the release said. “This agreement will provide certainty for members, providers and stakeholders as we work together to launch the fundamental transformation of the Medi-Cal program in 2024.”

The statement also cited DHCS’ commitment to pioneering Medicaid transformation across the country and within California. The state’s priority with the new contracts is to ensure that Medi-Cal members have access to health insurance plans that provide timely, high-quality care that are 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 that care for members is coordinated and that members have access to community services, the new contracts require partnerships with local health departments, local education and government agencies, and other local programs and services, such as social services, child welfare departments and justice departments. .

Under the new contracts, Medi-Cal members can expect coordinated access to care; those who need additional help will have access to care management based on individual needs, such as having a designated 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 into account members’ culture, sexual orientation, gender and gender identity, and language preference.

Medi-Cal 2024 MCPs and service areas include:

Blue Cross of California (“Anthem”) Partnership Plan 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. The CHG Foundation dba 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 the Los Angeles membership.