California Sets Medicaid Managed Care Lineup for 2024

As it seeks to transform Medi-Cal toward a population health approach that prioritizes prevention and whole-person care, the California Department of Health Care Services (DHCS) has finalized a lineup of Medicaid managed care plans (MCPs) for 2024.

Five commercial plans will be providing services to Medi-Cal managed care members in 21 counties across the state starting in January 2024: 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 Solution Inc., and Molina Healthcare of California.

California DHS and the insurers put out a joint statement about how Medi-Cal is being transformed. “We are committed to improving the healthcare 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. 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. We are committed to setting the stage for Medicaid transformation across the country as well as for broader health system innovation within California.”

As part of the agreement, Medi-Cal health plans will be held to new standards of care and greater accountability. These plans, and all other Medi-Cal managed care plan partners, will operate under the new MCP contract to provide quality, equitable and comprehensive coverage for Medi-Cal managed care members, the statement said.

As a result of these new contracts, the state said Medi-Cal members can expect:
• Coordinated access to care: Members who need extra help will have access to care management based on their healthcare needs. This means having a designated point person, a care manager, who can assist them and their families with navigating the healthcare system, handling referrals, and supporting communication with providers.
• More culturally competent care: Members will benefit from care and services that take into account their culture, sexual orientation, gender and gender identity, and preferred language.
• Better behavioral and physical health integration: Members’ physical health care will be better integrated with their behavioral healthcare, narrowing the divide between the two and improving access to mental health support and substance use disorder treatment.
• Focus on primary care use and investment: MCPs will be required to review utilization reports to identify members not accessing primary care. For example, if members are underutilizing primary care, they may not be obtaining appropriate screenings, preventive care, or managing their conditions to prevent exacerbation. The contract also includes steps to ensure MCPs are investing in primary care. Plans will be required report on primary care spending (as a percentage of total expenditures) to help ensure sufficient investment in upstream and preventive care.
• Reinvestment in community: For the first time, MCPs and their fully delegated subcontractors with positive net income will be required to allocate 5 to 7.5 percent of these profits (depending on the level of their profit) to local community activities that develop community infrastructure to support Medi-Cal members. Plan partners will be required to annually submit a Community Reinvestment Plan and Report that details how the community will benefit from the reinvestment activities and the outcomes of such investments.
• Robust engagement with community advisory groups: Historically, Medi-Cal MCPs are required to maintain a Community Advisory Committee (CAC) that serves to inform the plan’s cultural and linguistic services program. DHCS seeks to elevate the CAC by clarifying its role and member composition and prescribing the plan’s role in providing support for CAC members in order to maximize participation and involvement. In addition, CAC members will have the opportunity to serve on a DHCS Member Stakeholder Committee. MCPs will be expected to ensure that their CAC membership reflects that of the health plan and the county being served.
• Increased transparency: Members will have access to information that can guide them in choosing the best plan for their families and/or individual needs. Plans will also be required to routinely and publicly report on access, quality improvement, and health equity activities, including their fully delegated subcontractors’ performance and consumer satisfaction.