News

Medi-Cal Managed Care Plan Contracts Go-Live

On September 1, 2023, the Department of Health Care Services (DHCS) provided “go-live” decisions to all Medi-Cal managed care plans (MCPs) scheduled to assume operations on January 1, 2024, under the new MCP contract that requires all MCPs to advance health equity, quality, access, accountability, and transparency. These new contracts will serve approximately 99 percent of all Medi-Cal members. This change is part of California’s transformation of Medi-Cal to ensure members can access the care they need to live healthier lives. DHCS is developing webpages and materials targeted specifically to Medi-Cal members and providers that will offer more information, scheduled for posting in September. Check back here for details.

​​Kaiser MOU

DHCS entered into a Memorandum of Understanding (MOU) ​with Kaiser Foundation Health Plan, Inc. (Kaiser) as an alternate health care service plan (AHCSP), effective May 30, 2023, in accordance with AB 2724 (Chapter 73, Statutes of 2022). The MOU applies to the geographic areas of the 32 counties in which Kaiser will be directly contracted to serve and licensed by the Department of Managed Health Care.

As defined in AB 2724, Kaiser is subject to all of the same standards and requirements as other full-risk MCPs as part of the 2024 MCP contract, except those related to member enrollment. The MOU identifies DHCS' and Kaiser's responsibilities and obligations to each other in accordance with AB 2724; it memorializes commitments and requirements in the following areas:

• Enrollment processes, including, but not limited to, enrollment growth from geographic expansion, foster care youth and former foster care youth who elect to enroll in Kaiser, and members dually eligible for Medi-Cal and Medicare residing in Kaiser's geographic service areas, as well as annual enrollment growth through default enrollments in specific counties
• CalAIM's Enhanced Care Management and Community Supports implementation
• FQHC assistance with PHM and clinical transformation
• Specialty care services through certain pilot programs in partnership with certain FQHCs in identified geographical areas and specialties of need
• Reporting
• Collaboration with counties and local stakeholders
• Primary care physician assignment
• Behavioral health network adequacy and readiness​

Kaiser Enrollment​

Kaiser has committed to growth of new Medi-Cal members of 25 percent from July 1, 2024, (after the end of the PHE unwinding redetermination period and excluding any population growth resulting from the 2024 default enrollment requirements between January 1, 2024, and June 30, 2024) to the end of the contract term. There is no enrollment limit for the number of children in foster care, members dually eligible for Medi-Cal and Medicare, and other enrollment resulting from continuity of care rights.

Kaiser will comply with all enrollment requirements as stated in the MOU and direct contract, per AB 2724.

• Foster youth/former foster youth: Any foster youth/former foster youth residing in Kaiser's footprint can enroll in Kaiser's Medi-Cal plan.
• Dually eligible members: Any dual member (enrolled in both Medicare and Medi-Cal) residing in Kaiser's footprint to enroll in Kaiser's Medi-Cal plan.
• The following members can enroll in Kaiser's Medi-Cal plan:
• A Medi-Cal member previously enrolled with Kaiser as their MCP at any point between January 1, 2023, and December 31, 2023.
• A Medi-Cal member who is an existing Kaiser member upon transition into Medi-Cal managed care.
• A Medi-Cal member who was a member of Kaiser at any time during the 12 months preceding the effective date of their Medi-Cal eligibility.
• A Medi-Cal member with family linkage to Kaiser.
• ​A Medi-Cal member previously enrolled in a primary MCP other than Kaiser at any point from January 1, 2023, to December 31, 2023, inclusive, but who was assisted to, and made the responsibility of, Kaiser under a subcontract with that primary MCP.​​

​The 2024 annual default enrollment ceiling is 3,000 members. This is in addition to Kaiser's projected growth in 2024, as required in the MOU from geographic expansion into 10 new counties, foster youth/former foster youth who elect to enroll into Kaiser, and dually eligible members residing in Kaiser's footprint.

Note: Kaiser will not receive 2024 default enrollment based on the auto assignment incentive program in the following counties: Alameda, Amador, Contra Costa, El Dorado, Fresno, Imperial, Kings, Madera, Marin, Mariposa, Napa, Orange, Placer, Sacramento, San Joaquin, San Mateo, Santa Cruz, Solano, Sonoma, Stanislaus, Sutter, Tulare, Ventura, Yolo, Yuba.