Madeline Shannon | Feb 28, 2020
The Senate Budget Committee and Senate Health Committee met Wednesday in a joint meeting with officials from the Department of Health Care Services (DHCS) to discuss the timeline for the state’s procurement of Medi-Cal contracts, as well as present a proposal for a new program, “Medi-Cal Healthier California for All.”
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According to Sen. Richard Pan (D-6th District), one-third of all Cailfornians are covered by Medi-Cal, and about half of all children in the state. Medi-Cal managed care plans, by the same token, deliver care to 10.5 million residents of California, Pan said.
“We still have access and quality issues that are continuing to persist,” Pan added. “Too many children are still not getting their regular check-ups, and more than half don’t get their regular medical supervision visits. In rural communities…people have challenges getting specialty care.”
The CalAIM program, among its chief goals, aims to implement a health care delivery system and payment reform for Medi-Cal. It specifically tries to address homelessness and behavioral health issues.
“We do need to hold plans accountable when they don’t meet the needs of the beneficiaries,” Pan added during the meeting. “We also need to hold the Department of Health Care Services accountable, in particular, when those needs are not met.”
DHCS, in an effort to meet those goals, aims this year to once again procure Medi-Cal managed care plan contracts and launch the “Medi-Cal Healthier California for All” program, which is set to improve health outcomes for the state’s Medi-Cal beneficiaries.
DHCS plans to start the RFP process in April of this year, allowing a 30-day comment period to invite more feedback. The department would then release a draft RFP in December 2020. The final RFP would be released in June 2021, with proposals due in August of that year. Notices of intent will be sent out by December 2021. Once a proposal is approved, DHCS plans to stagger implementation in January 2023 or 2024.
Officials from DHCS announced plans to re-procure Medi-Cal managed care plan contracts this year, impacting counties that utilize the Two-Plan Model. This plan requires counties to supply a county-managed plan, as well as contract with a commercial provider to provide a commercial plan.
Managed care plans in counties that use the Geographic Managed Care model would also be affected, which has counties contract with commercial managed care plan providers. The other type of managed care plans to be affected by the DHCS re-procurement are plans that operate under the Regional Model, which has beneficiaries receive medical services through Anthem Blue Cross or California Health & Wellness.
“The next big thing we look to is the procurement in front of us,” said Jacey Cooper, state Medicaid director and chief deputy director of health care services. “The department is embarking on a managed care plan procurement of our managed care plans in 36 counties, which is the first procurement we’ve gone through in a very long time in California.”
Cooper added the department will look for a history of providing high-quality care to Medi-Cal managed care plan recipients as the procurement moves forward, as well as an ability to continually improve the quality of care to plan beneficiaries. Plans that can ensure access to medical services through an adequate network will also be important to the department as DHCS officials re-procure these contracts.
“We will focus on preventative services and early intervention,” Cooper said. “That’s going to be very important to us, is making sure people have a comprehensive plan that makes sure they can provide preventative services to our beneficiaries.”
The re-procurement also means expanding the Two-Plan Model, the Geographic Managed Care Model and the Regional Model, and DHCS plans to send out a request for proposals to acquire proposals from commercial managed care plans to provide medical services to Medi-Cal beneficiaries. Contracts between DHCS and commercial managed care plans will likely include several new service and oversight requirements.
