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- August 19, 2014
Managed Care in CA Series, Issue 1: Network Adequacy Laws (Revised May 7, 2018)
Read moreManaged Care and California Series Issue 1: Medi-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…
- 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…
- 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,…
- March 25, 2014
California Health Benefit Exchange 2012-2013 Draft
Read moreWe are writing on behalf of the Health Consumer Alliance (HCA), a statewide collaborative of consumer assistance programs operated by community-based legal services organizations, which includes: BayArea Legal Aid, California Rural Legal Assistance, Central California Legal Services, Greater Bakersfield Legal Assistance, Legal Aid Society of Orange County, Legal Aid…
- February 5, 2014
Medicaid Managed Care and Women’s Health
Read moreOver the past 30 years, managed care has become the dominant service delivery model used for Medicaid programs across the country. The majority of low-income women and children enrolled in Medicaid now obtain services through managed care plans. A key feature of many managed care arrangements is the requirement…
