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- August 19, 2014
Managed Care in California Series, Issue 2: Network Adequacy Laws in Covered California Plans
Read moreManaged Care and California Series Issue 2: Covered California QHPs receive a set premium payment ("capitation") per enrollee in exchange for providing services. The plans accept the risk of incurring a loss if they spend more on services than they receive through the premium payments, but they will make…
- May 30, 2014
Lessons from CA: Delaying 2014 Renewals for Medi-Cal Enrollees
Read moreIn June, current enrollees of California's Medicaid program, Medi-Cal, will be asked to complete a new renewal process and be evaluated under the new MAGI eligibility rules. But with nearly one million Medi-Cal applications still pending and a faulty IT system unable to accurately determine Medi-Cal eligibility, hundreds of…
- May 8, 2014
Network Adequacy Laws in Medi-Cal Managed Care Plans
Read moreMedi-Cal managed care plans are capitated, meaning they receive a set payment per enrollee per month in exchange for providing services.The plans contract on a "comprehensive risk" basis, which means they accept the risk of incurring a loss if they spend more on services than they receives through the…
- April 29, 2014
Re: California’s Bridge to Reform Demonstration (No. 11-W-00193/9)
Read moreThere are three major components of the CCI. As drafted, the amendment repeatedly fails to effectively delineate what changes are occurring under each of these separate components. The amendment frequently conflates the three components of the CCI, muddling an already complicated set of changes. The amendment should set forth,…
- April 28, 2014
Comments on 90-day MLTSS Duals Notice and 45-day MLTSS Notice
Read moreAs a preliminary matter, we urge DHCS to also provide the draft notices directed to seniors and persons with disabilities (non-duals) who will have to choose a Medi-Cal managed care plan for the first time for stakeholder review and comment. Most notably, this group includes individuals living in a…
