Medi-Cal Managed Care Plan Contract Information for Medi-Cal Providers
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Improvements are coming to Medi-Cal Managed Care Plans in 2024
DHCS is partnering with Medi-Cal managed care plans (MCPs) to make sure your patients have improved access to high-quality and coordinated care. Many of these improvements are already happening. In 2024, new MCPs will be available in some counties, some MCPs will continue to operate in the counties they operate in today, while other MCPs will no longer be available. Please see the county chart to learn if your contracts with MCPs will need to change.
By putting in place a new contract with all MCPs, California seeks to ensure that MCPs are committed to, capable of, and accountable for meeting the state’s goal of achieving a Healthier California for All.
DHCS is working closely with providers and has dedicated resources to connect you with MCPs in your county/service area.
Medi-Cal MCPs will remain the same in 2023, except for United Healthcare, whose managed care plan contracts ended on December 31, 2022. DHCS is working with MCPs on readiness and transition planning and will share more information with providers through email and webinars.
DHCS will assess network adequacy to ensure that plans entering a market have sufficient capacity to provide covered Medi-Cal services. DHCS will also review MCP networks to assess overlap of providers, and work with exiting and entering plans to obtain transition plans that ensure continuity of care, especially for members with complex conditions. Medi-Cal managed care plans operating in your area may reach out to you for the purposes of credentialing, contracting, or other steps needed to develop a robust provider network for their members to access care.
Why is this happening?
Medi-Cal is requiring all health plans to meet new standards of care and increase transparency, accountability, and efficiency to drive improvements in Medi-Cal member experience and the health care they receive. Members can expect from their MCP:
- Coordinated access to care
- Culturally appropriate care
- Integrated physical and behavioral health services
- Transparency and access to information
Medi-Cal managed care members can expect more comprehensive, holistic, coordinated, and integrated care when the new MCP contract is implemented in January 2024. Members will have better access to culturally competent care and Community Supports that address social needs, such as food and housing insecurity. Enrolled children will have enhanced access to services that support their physical, social, and emotional development in schools and other community settings. Behavioral health will be better integrated with the physical health care system, including “No Wrong Door” policies to support access, narrowing the divide between the two and improving access to mental health support and substance use disorder treatment.
Importantly, every member will have a comprehensive benefits package no matter where they live, and they won’t have to worry about a change in their benefits if they move to another county within the state. Members will also have access to information about plan performance that can guide them in choosing the best plan for their needs.
How should I advise my patients?
- DHCS is working to ensure that member care, treatments, and services stay the same or improve. There are also NO changes coming to the Program of All-Inclusive Care for the Elderly (PACE) specialty plans. If a member’s Medi-Cal health plan is Kaiser, they will remain with Kaiser.
- DHCS is taking steps to ensure a smooth and safe transition for members switching from an exiting MCP to a new MCP. If a patient’s health plan will change in 2024, they will receive information about their options in late 2023 and any actions they may have to take.
- Medi-Cal will work to ensure member care and treatments stay the same (also known as Continuity of Care). DHCS is taking steps so that most members who have to change plans can keep their current provider. Medi-Cal and their plan will prioritize members’ Continuity of Care. Before the end of 2022, DHCS will publish the Continuity of Care APL guidance to MCPs and will distribute a flyer through multiple channels, including MCPs, Medi-Cal county eligibility offices, DHCS Ombudsman, Health Care Options, and providers, among others.
- We expect members to have no disruption of their pharmacy benefits during this transition because pharmacy benefits are carved out of managed care, and (as of January 1, 2022) are administered by DHCS under Medi-Cal Rx.
Where can I get help and more information?
Learn More About the Procurement
