County Organized Health System Medi-Cal Plans

Executive Summary

In certain counties, Medi-Cal managed care is operated by a single County Organized Health System (COHS). In COHS counties, a single plan serves all Medi-Cal beneficiaries who are enrolled in managed care. Unlike other Medi-Cal managed care plans, COHS plans are not required to obtain Knox Keene licensure for their Medi-Cal lines of business, and unless they choose to obtain a Knox-Keene license, they are not directly regulated by the DMHC. Consumer advocates should be aware of the differences in the protections available in COHS plans from those provided by the Knox Keene Act licensed plans, in order to understand the rules and consumer protections that are available within the plans and to know what regulatory agency is responsible to monitor and enforce compliance.