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- 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…
- 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…
