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- November 20, 2014
Lessons from CA: Marketplace Renewals
Read moreIn this month's Lessons from California, we review the annual renewal process for Covered California's (California's state marketplace) enrollees and where it differs from the renewal process in the federally facilitated marketplace (FFM). As this is the first renewal period for all marketplaces, best practices will become clearer for…
- October 29, 2014
Lessons from CA: Covering Behavioral Health Treatment in Medi-Cal
Read moreIn this month's Lessons from California, we highlight how NHeLP is working with advocates in California to ensure the state is following the federal guidelines from CMS on providing Behavioral Health Treatment to children with Autism Spectrum Disorders and that children receive the treatment they need under Medi-Cal.
- September 30, 2014
Lessons from CA: Contraceptive Coverage
Read moreIn this month's Lessons from California, we highlight landmark legislation, the Contraceptive Coverage Equity Act (SB 1053, Mitchell), the state just enacted that requires that Medi-Cal managed care organizations (MCO) and most private insurers cover all FDA-approved methods and strictly limits MCO medical management techniques. These important new state…
- September 29, 2014
County Organized Health System Medi-Cal Plans
Read moreIn 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…
- August 28, 2014
Lessons from CA: Medicaid Estate Recovery
Read moreCalifornia is among a limited number of states that recovers against the estates of its Medicaid beneficiaries for more than what is federally required, which has been identified as a barrier to enrollment. This year, California is attempting to address this issue through legislation, which the state legislature passed…
- 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…
