The California Department of Health Care Services (DHCS) has finalized an agreement with five commercial managed care plans to deliver Medi-Cal services in 21 counties across the state, including San Diego, starting in January 2024.
The move ends an ongoing effort to consolidate the number of private companies DHCS allows to manage Medi-Cal benefits in markets across the state and means far fewer San Diego County residents on Medi-Cal will have to change health plans.
A DHCS announcement last summer stirred controversy when it awarded management of nearly 900,000 San Diego County Medi-Cal beneficiaries to Health Net, Molina Healthcare, and Kaiser Permanente, leaving out the region’s largest Medi-Cal operator, Community Health Group (CHG). The move was particularly controversial because CHG is a home-grown company with about 330,000 local beneficiaries and a robust roster of contracted medical providers.
In addition to CHG, contracts in San Diego will be awarded to Molina, Blue Shield, and Kaiser. It is estimated that fewer than 100,000 Medi-Cal beneficiaries will have to change plans, far less than was expected after the initial summer announcement.
According to DHCS, these plans, and all other Medi-Cal managed care plan partners—including public plans and Kaiser Permanente—will operate under a new, rigorous contract to provide quality, equitable and comprehensive coverage for Medi-Cal managed care members. To help address the social drivers of health, the new contracts require partnerships with local health departments, local educational and governmental agencies, and other local programs and services, including social services, child welfare departments, and justice departments, to ensure member care is coordinated and members have access to community-based resources.
In its statement, the DHCS said that the new contracts with health plans will hold them to “new standards of care and greater accountability, helping to ensure Medi-Cal members have the support they need to live healthier, more fulfilling lives.”