Beginning in 2024, all Medi-Cal managed care plans (MCP) will have additional requirements to advance quality, equity, accessibility, accountability, and transparency. To make effective these improvements, the Department of Health Care Services (DHCS) has made changes to the MCPs available for Medi-Cal members. The 2024 Medi-Cal MCP partners have demonstrated their commitment to Medi-Cal transformational efforts over the next few years. Therefore, MCPs for some Medi-Cal members may change, and some members will transition to a new MCP on January 1.
Medi-Cal's top priority is to drive improvements in our delivery system so that all members have access to timely, high-quality care from all MCPs in all counties. For members who must change MCPs, DHCS is working to ease member transitions to new MCPs by protecting continuity of care and coverage. We spoke with Susan Philip, Deputy Director of DHCS' Health Care Delivery Systems, and Dana Durham, Chief of DHCS' Managed Care Quality and Monitoring Division, to learn more about the transition and what it means for members.
1. How has DHCS improved its contract with MCPs?
By 2024, about 99 percent of Medi-Cal members will receive most of their Medi-Cal benefits through MCPs. DHCS is working to ensure that all Medi-Cal members have access to MCPs that deliver high-quality care. Over the last couple of years, DHCS reconsidered the MCPs it partners with to serve Medi-Cal members and established our intent to offer a new mix of available high-quality MCPs. DHCS sought to transform Medi-Cal managed care in multiple ways.
First, we restructured and revamped our model contract under which all MCPs statewide will operate. That updated contract includes more robust provisions that are intended to enhance how care is delivered to Medi-Cal members. The provisions are focused on advancing health equity, quality, access, accountability, and transparency in the managed care program.
The next major effort was county MCP model changes. Counties had an opportunity to consider the MCP model that operates in their county and change it. Seventeen counties expressed a desire to change their Medi-Cal managed care model type to a Single Plan or County Organized Health System. Those changes were approved by DHCS and the federal government.
Finally, at the end of 2022, we announced contracts with five commercial plans to serve Medi-Cal members in 21 counties. DHCS also entered into a direct contract with Kaiser Permanente, which will allow Medi-Cal members who have Kaiser to continue to have Kaiser and also allows for limited enrollment for members meeting eligibility criteria in 32 counties.
2. For the members who need to change plans, how is DHCS working to minimize potential service disruptions?
We're making sure that during the MCP transition period—which begins on January 1, 2024, when membership in a new MCP is effective—our members experience the least amount of disruption possible. Our priority is to create a smooth and effective transition for members changing MCPs. We are monitoring how MCPs implement transition activities. Our goal is to minimize any service disruptions by protecting continuity of care for members required to transition on January 1. We're especially watching members most at risk for harm or disruptions in care.
We have a dedicated webpage on the DHCS website that highlights how we're working to make sure members continue receiving covered services even as they transition MCPs. Please know that not every member is transitioning plans, so we are working to provide outreach, education, and clear communication to affected members, providers, and stakeholders.
3. How will DHCS ensure the needs of members with complex and/or chronic conditions continue to be covered during the MCP transition?
All members required to transition MCPs on January 1 can request continuity of care, but members with identified vulnerabilities will have enhanced protections to minimize the risk of harm. These special populations are living with complex or chronic conditions. They may include adults and children who receive Enhanced Care Management and Community Supports services, and members who are receiving treatment for end-stage renal disease, hospital inpatient care, hospice or palliative care, and more.
Our priority is to minimize disruptions for these vulnerable members. Therefore, DHCS developed a process for new MCPs to be aware of their incoming members and their needs ahead of the transition so they can begin arrangements for continuation of services. Transitioning members will be identified using either DHCS or previous MCP data. The new MCP will receive these data in advance of the January 2024 transition. MCPs are required to take proactive steps to implement continuity of care for these special populations. They'll conduct outreach to members and providers, and there will be a data transfer between MCPs. We're taking steps to maintain the member's relationship with their primary care provider. DHCS will monitor continuity of care for these special populations as part of its transition monitoring.
For more information about the MCP transition, continuity of care, and other important Medi-Cal information, visit the Medi-Cal MCP Transition Member FAQs webpage.
