Biweekly Briefing Articles

Drastic Changes Ahead for Medi-Cal Contracts

By year’s end, we should know which two health plans the state has chosen to administer Medi-Cal contracts in San Diego County.

While the Department of Health Care Services’ (DHCS) decision to drastically change the Medi-Cal managed care markets throughout the state won’t take effect until 2024, there is already concern over gaps and challenges this may create. Not to mention the logistical challenges in San Diego County, where five plans will be eliminated by going from seven to two. As we’ve seen the number of Medi-Cal recipients increase exponentially, with the potential to keep climbing, it’s important to get this right — for both hospitals and the broader communities we serve.

A draft of the request for proposals (RFP), which will open all Medi-Cal managed care markets to potential new models or health plans, was released June 1 for comment. Imperial County has already submitted a formal request to create a new County Organized Health System with California Health and Wellness.

In advance of the RFP release, at the most recent HASD&IC Board of Directors meeting, time was spent discussing the changes that are coming to the Medi-Cal program throughout the state. The HASD&IC board has developed six guiding principles that outline the hospital and health system perspective on key components and priorities for inclusion in any new Medi-Cal managed care contracts:

  1. DHCS, counties, and other decision-makers should prioritize hospital and health system input when developing RFP standards and evaluating proposals.
  2. DHCS must clearly enunciate its policies and enforce standard Medi-Cal managed care requirements on network delegation and subcontracting.
  3. DHCS must ensure that all Medi-Cal managed care payers cover the full scope of services provided by Medi-Cal fee-for-service (including EPSDT).
  4. Medi-Cal managed care contracts should include clear, enforceable requirements for timely and accurate payment.
  5. Medi-Cal managed care plans must be held to explicit requirements to support patients with care coordination and appropriate placement after hospitalization.
  6. All new Medi-Cal managed care contracts must impose requirements for accurate data collection and reporting.

While there is no guarantee that the state will make the shift to two Medi-Cal plans, there is certainly the intent, and that has a lot of plans on edge.

As always, we’re continuing our efforts to advocate and educate on this and all matters that are vital to hospitals and we keep you apprised of any changes.