Medi-Cal Managed Care Plan Transition​

Beginning in 2024, Medi-Cal health plans will have new requirements to advance quality, access, accountability, health equity, and transparency.

Some Medi-Cal members in 21 counties may need to transition to a new health plan on January 1, 2024.​

This change does not affect members’ Medi-Cal coverage or benefits. Members’ Medi-Cal coverage and benefits will stay the same even if their Medi-Cal health plan changes.​

What this change means for Californians

As a result of the new requirements, members can expect the following improvements:

• Coordinated access to care: Members who need extra help will have access to care management based on their health care needs. This means having a designated point person, a care manager, who can assist them and their families with navigating the health care system, handling referrals, and supporting communication with providers.
• More culturally competent care: Members will benefit from care and services that take into account their culture, sexual orientation, gender and gender identity, and preferred language.
• Better behavioral and physical health integration: Members’ physical health care will be better integrated with their behavioral health care, narrowing the divide between the two and improving access to mental health support and substance use disorder treatment.
• Focus on primary care use and investment: MCPs will be required to review utilization reports to identify members not accessing primary care. For example, if members are underutilizing primary care, they may not be obtaining appropriate screenings, preventive care, or managing their conditions to prevent exacerbation. The contract also includes steps to ensure MCPs are investing in primary care. Plans will be required report on primary care spending (as a percentage of total expenditures) to help ensure sufficient investment in upstream and preventive care.
• Reinvestment in community: For the first time, MCPs and their fully delegated subcontractors with positive net income will be required to allocate 5 to 7.5 percent of these profits (depending on the level of their profit) to local community activities that develop community infrastructure to support Medi-Cal members. Plan partners will be required to annually submit a Community Reinvestment Plan and Report that details how the community will benefit from the reinvestment activities and the outcomes of such investments.
• Robust engagement with community advisory groups: Historically, Medi-Cal MCPs are required to maintain a Community Advisory Committee (CAC) that serves to inform the plan’s cultural and linguistic services program. DHCS seeks to elevate the CAC by clarifying its role and member composition and prescribing the plan’s role in providing support for CAC members in order to maximize participation and involvement. In addition, CAC members will have the opportunity to serve on a DHCS Member Stakeholder Committee. MCPs will be expected to ensure that their CAC membership reflects that of the health plan and the county being served.
• Increased transparency: Members will have easy access to information that can guide them in choosing the best plan for their families and/or individual needs. Plans will also be required to routinely and publicly report on access, quality improvement, and health equity activities, including their fully delegated subcontractors’ performance and consumer satisfaction.​
  

Medi-Cal's top priority is to ensure that all members have access to timely, high-quality care from all health plans statewide. This health plan transition is part of California’s transformation of Medi-Cal​ to ensure members can access the care they need to live healthier lives.

Guiding Principles​