***Co-Authored by Abigail Coursolle, NHeLP and Whitney Francis, Western Center on Law and Poverty
This week, Governor Newsom signed into law Senate Bill 530 (SB 530), authored by Senator Laura Richardson (D-South Bay). SB 530 takes important steps to ensure that people enrolled in Medi-Cal Managed Care Plans have access to the health care services they need. At a time when federal funding threats loom and state resources must be spent judiciously, SB 530 demands accountability from Medi-Cal Managed Care Plans, ensuring that the billions of dollars invested in Medi-Cal translate to real and timely access to care, not just coverage on paper.
More than 14 million Californians, including low-income children, older adults, and people with disabilities, are enrolled in a Medi-Cal Managed Care Plan. Over the past 30 years, California has increasingly moved beneficiaries into a capitated managed care delivery system. Today, nearly all beneficiaries now receive their care through a Medi-Cal Managed Care Plan, including those who reside in residential facilities, pregnant people, children with special health care needs, and people with other health coverage. Medi-Cal Managed Care Plans are responsible for providing their members with most of the health care services covered in the Medi-Cal program – from primary care to physical therapy, to specialty visits.
Yet there has been an increasing volume of approved alternative access requests in recent years. Alternative access requests are an exception process to the existing standards that allow Medi-Cal Managed Care Plans to not meet provider or facility time and distance standards. When alternative access requests are granted, this can mean that people on Medi-Cal sometimes must travel double the time or distance deemed acceptable by law just to get the care they need. The uptick in approved alternative access requests suggests that more Medi-Cal beneficiaries are traveling longer and farther to access health care services, which raises concerns about healthcare accessibility, given that beneficiaries already often struggle to obtain timely care under existing standards. SB 530 is important to hold Medi-Cal Managed Care Plans accountable for delivering necessary care to Medi-Cal members, within a reasonable time and distance, and without inappropriate delays.
One way that SB 530 ensures that Medi-Cal Managed Care delivers necessary care is by extending and strengthening network adequacy standards. In 2017, California first established network adequacy standards for Medi-Cal Managed Care Plans, including time and distance standards for Medi-Cal enrollees to obtain primary care, certain specialty, mental health, dental, and pharmacy services, as well as appointment wait time standards. These standards were set to expire on January 1, 2026. SB 530 extends the existing requirements until 2029, which will protect against Medi-Cal Managed Care Plans narrowing their networks in the coming years. In addition, SB 530 requires Medi-Cal Managed Care Plans to document their efforts to contract with local providers before an alternative access request may be granted.
SB 530 also lays the groundwork for improving on the existing standards—for the first time since the standards were put into place nearly 8 years ago—to better ensure that Medi-Cal Managed Care Plan members have real access to care. The law requires the Department of Health Care Services to convene a stakeholder workgroup in the development of updated network adequacy standards, ensuring transparency and accountability in that process. The law provides the agency with time to develop updated standards in a transparent manner, using both data and input from important stakeholders. Given the growth in the number of Californians who rely on Medi-Cal plans to receive care, it is important to review the wealth of available data and identify barriers to access that should inform the standards.
Finally, SB 530 codifies California’s commitment to complying with federal Medicaid Managed Care regulations that were promulgated in 2024. The federal regulations will require California to implement a secret shopper process to verify that providers listed in Medi-Cal Managed Care Plan provider directories are actually available to deliver services to members, and to confirm the availability of timely appointments. SB 530 will ensure that California takes the necessary steps to implement these important federal requirements.
While SB 530 takes many crucial steps to ensure that Medi-Cal Managed Care Plans are held accountable for delivering covered services to Medi-Cal members, there is more work ahead. The California Medi-Cal agency, in partnership with the state legislature, must ensure the updated network adequacy standards reflect the services most needed by Medi-Cal members. The process for reviewing and approving alternative access standards can be further strengthened. And once the secret shopper survey process is implemented, California can use the survey results to pinpoint areas where there are provider shortages, or where timely access is not being delivered.
California is currently facing significant threats to Medi-Cal funding. It is more important than ever to use our funds wisely to ensure that the Medi-Cal Managed Care Plans we pay to deliver services to low-income Californians provide real access to primary care appointments, specialists, mental health services, and other necessary health care services.
