Healthcare leaders discuss Medi-Cal Managed Medical Care Contracts 2024 – State of Reform

To promote health equity, quality, access, accountability and transparency, the new Medi-Cal Managed Care Plan (MCP) contracts will go into effect statewide in California starting January 2024. MCPs perform a key role in CalAIMwhich 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. The Blue Shield of California Promise Health Plan and CHG Foundations Community Health Group Partnership Plan will both serve San Diego County. Health Net will serve ten counties and subcontract 50 percent of its membership to Molina County. Molina Healthcare of California will serve four counties and serve as a subcontractor for Health Net in Los Angeles County for 50% of its members.

A diverse group of experts spoke about the importance of the new contracts at the 2023 Northern California State Health Policy Reform Conference. Susan Phillip, deputy director of Health Care Delivery Systems for the California Department of Health Services, spoke on the issue .

By 2024, 99 percent of Medi-Cal beneficiaries will have a managed care plan, so managed care is really how we service our Medi-Cal beneficiaries in California, Phillip said.

Phillips explained how all MCPs are required to undergo rigorous readiness processes, which have been taking place since 2022. The purpose of the readiness review is to ensure plans are prepared to meet the new contractual requirements.

One of the major changes focuses on transparency and requires plans to report publicly and regularly on access, quality and healthcare equity, Phillip said. He added that the plans will need to publish their investment plans in the community, which show how the plans are taking the excess revenue and putting it back into the community.

DHCS states that MCP and their fully delegated subcontractors have net positive 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 detailing how the reinvestment activities will benefit communities and investment results. Additional transparency measures include, among others, annual consumer satisfaction surveys.

Another key provision relates to local presence and engagement. Phillip said there\’s a new section in the contract that calls for community engagement with members and families and working with local community-based organizations to bring their perspectives into the conversation.

We\’re really working with our floor partners to think about all the different moving pieces, and I mean, there\’s four different workflows, Phillip said. First, there is a review of the contract results. There is guidance, development and control. There\’s something we call 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 leaving contract understand who their members are and can maintain that continuity of care. As part of their communications efforts, DHCS will be contacting members 90 days, 60 days and 30 days prior to the transition to provide clear instruction and communication to members.

2024 transition policy guide, which shows what steps plans need to take to enter and exit contracts, is under development; the first chapter of the policy guide, which focuses on continuity of care, was released several weeks ago, Phillip said, and more chapters will be released in the coming weeks.

Rebecca Sullivan, director of government affairs for California Local Health Plans (LHPC), also attended the conference and provided input from a local health plan perspective. LHPC operates in 36 of California\’s 58 counties and, by 2024, said 51 of California\’s 58 counties will have a local presence.

For these expansion plans in particular, operational readiness takes on a slightly different meaning, Sullivan said. It is critical to the success of this transition that we increase local connections and relationships with our suppliers, our counties and the communities we serve.

Sullivan mentioned how many of the new requirements in the 2024 Medi-Cal MCP contract will require additional resources, including personnel. Existing staff will be asked to take on an increased workload and new people will need to be hired. given that shortage of health personnelSullivan added that hiring additional staff creates time constraints.

There\’s still a long way to go in understanding the policies that are coming out some of these policy guidance documents that are coming out and we just want to make sure they\’ve been deliberate during implementation so we don\’t disrupt these existing initiatives and the current il work that is done is really important, Sullivan said.

According to the DHCS, the new contracts will allow for more culturally competent care, as beneficiaries will receive care and services that take into account their culture, sexual orientation, gender identity and preferred languages.

Beneficiaries can also expect to receive better integration of behavioral and physical health as DHCS prioritizes bridging 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 not accessing primary care, implying they may not be screened or preventative care.

As a system, we need to ensure there is coordination across the system to streamline processes by leveraging existing work that is being done, Sullivan said.