Medi-Cal Managed Care Procurement and Updated Contract
TRANSFORMING MEDI-CAL MANAGED CARE TO IMPROVE EQUITY, QUALITY, ACCESS, AND TRANSPARENCY
Learn more about the procurement
Medi-Cal Procurement and Updated Contract Aims to Improve Care Delivery to Enrollees
The Department of Health Care Services (DHCS) is redefining how care is delivered to more than 12 million Californians through a
Request for Proposal (RFP) for commercial Medi-Cal managed care plan contractors. Raising the state’s expectations of plans in the Medi-Cal program, the restructured and more robust managed care contract reflects DHCS’ intention to hold all plan partners and their subcontractors more accountable for:
- High-quality, accessible, and comprehensive care across all settings and levels of care
- Reducing health disparities
- Improving health outcomes
These new contracts will apply to
all Medi-Cal managed care plans effective January 1, 2024. In parallel with the commercial plan procurement, DHCS has provided conditional approval to 17 counties to change the type of managed care model in which they participate and proposed a direct contract with Kaiser in 32 counties, subject to state and federal approval.
Medi-Cal Members to Receive Person-Centered Care and Social Services
Medi-Cal managed care members can expect more holistic, coordinated, and integrated care when the new managed care plan contract is implemented. From birth to dignified end of life, members will have better access to culturally competent care, behavioral health services, and other community supports that address social needs such as food and housing. Enrolled children will have enhanced access to services that support their physical, social, and emotional development in schools and other community settings.
Plan Partners Will Commit to Meeting Stronger Contract Requirements
DHCS is seeking plan partners that demonstrate their ability to meet new and enhanced requirements to advance equity and improve population health. This includes stronger requirements related to accessing providers, engaging with community-based organizations, and implementing expanded care management and other population health programs. Plans will be required to meet higher quality improvement benchmarks and make public their quality improvement and equity activities. Plan partners will also commit to implementing and supporting the initiatives of CalAIM, which serves as the framework for Medi-Cal transformation.
DHCS Commits to Enhanced Oversight Activities
DHCS is improving its oversight of plan partners and their subcontractors to ensure greater transparency and accountability. DHCS will link its payments to plans more closely to value so as to advance care that is higher quality, more equitable, and more efficient. Requirements to maximize the share of funds that plans spend on medical care and quality improvement, as opposed to administrative overhead, will be strengthened. DHCS will also expand reporting related to expenditures and quality.
Managed care plan proposals are due April 11, 2022. DHCS expects to award contracts to selected plans in August 2022. New contracts will become effective on January 1, 2024.