1 Current enrollment in the existing nine commercial plans across these affected counties is approximately 3.4 million members, with total payments to health plans of more than $13 billion. If the managed care models remain the same, 36 counties will go through reprocurement. The upcoming procurement includes only commercial plans and is technically not applicable to County Organized Health Systems or local initiatives (although the contract changes that accompany the procurement will apply to all Medi-Cal managed care plans).ĭHCS is engaging in a request for proposal (RFP) by which the health plans most qualified are selected.
Medi-Cal managed care procurement is an opportunity for DHCS to evaluate whether to continue its relationships with current Medi-Cal managed care plans, enter into contracts with new plans, reexamine expectations of those plans, or some combination of these. Procurement is the process of purchasing goods or services. Medi-Cal Managed Care Plan Procurement Impact on Commercial Plans This brief explains what that process is and what it means for the future of Medi-Cal managed care and the Californians it serves.
In total, Medi-Cal covers more than 13.4 million Californians, and managed care plans provide coverage to nearly 84% of them.īeginning in 2021, the California Department of Health Care Services (DHCS), which administers the Medi-Cal program, will engage in a reprocurement process for all commercial managed care plans. Medi-Cal is California’s Medicaid program, providing health coverage to Californians with low incomes, including approximately 5.4 million children and youth under the age of 21, over a million seniors, about half of all Californians with disabilities, and around one in six workers. The series provides an overview of the program, including the people it serves, the services it provides, and how it is organized, managed, and financed. These fact sheets are part of CHCF’s Medi-Cal Explained series.
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