California Medicaid contracts with Molina, Centene, Elevance

California regulators intend to award coveted 5-12 months Medicaid managed care contracts to Molina Healthcare, Centene subsidiary well being internet and Elevance well being’s Anthem Blue Cross Partnership Plan, the state division of well being Care companies introduced Thursday.

Medi-Cal is the most important Medicaid program and coated 14.6 million decrease-income people as of February, in line with the most modern state knowledge. The contracts run from Jan. 1, 2024 to Dec. 31, 2028.

The three insurance coverage corporations already held Medicaid contracts with California. the mannequin new preparations characterize the Golden State’s first-ever statewide managed care plan procurement they typically require insurers to implement new cost, extreme quality and transparency measures. CVS well being’s Aetna, Blue defend of California, chinese language group well being Plan, group well being Group and UnitedHealth Group’s Imperial well being Plan weren’t chosen. UnitedHealth Group will cease overlaying Medi-Cal enrollees by the tip of the 12 months, division of well being Care companies Director Michelle Baass acknowledged all by means of a name with reporters. well being plans that misplaced bids have till Sept. 1 to enchantment. 

not one in all of the worthwhile or dropping corporations immediately responded to interview requests. 

Cetene gained the Medicaid contract regardless of a state investigation into allegations that the agency defrauded Medi-Cal over prescription drug prices. the most important Medicaid insurer reserved $1.25 billion to settle comparable claims with eleven fully different states that its former pharmacy revenue supervisor division inflated drug prices. California regulators fined then-Centene subsidiary Magellan well being $three.eight million this 12 months after worker shortages left sufferers and suppliers ready on prior authorization approvals. Centene covers 2.14 million Medi-Cal beneficiaries.

California additionally will transfer forward with a plan for Kaiser Permanente to broaden its Medicaid contract and proceed choosing the people it enrolls, which rival well being insurers argue permits the constructed-in well being system to cherry choose extra healthful prospects. The state has has prolonged permitted Kaiser Permanente to restrict its Medi-Cal membership to current former Kaiser Permanente employer-primarily based or particular person  policyholders. 

Gov. Gavin Newsom (D) enacted legal guidelines in June that instantly contracts with Kaiser Permanente in 32 counties and might enhance its enrollment by 25% over the 5-12 months time period, in line with the California Senate well being committee. the agency had better than 896,200 Medi-Cal members on the tip of June, and instantly operates or subcontracts with native plans in 17 counties. The settlement is pending federal approval. Kaiser Permanente did not immediately reply to an interview request. 

the overwhelming majority of Kaiser’s geographic footprint and enrollment stem from subcontracting with county-run insurers, which is liable to be eradicated beneath the mannequin new regulation. the mannequin new statewide contract requires Kaiser Permanente to sort out hazard and instantly finance its members’ care. 

the current subcontract association is unnecessarily difficult and a single, direct contract would create a extra shopper-nice expertise, in line with a report the state Senate well being committee issued in June. The native well being Plans of California commerce affiliation and a quantity of fully different counties additionally contend the mannequin new mannequin weaken entry to care as a outcome of it excludes suppliers and companies outdoors of the Kaiser Permanente system.

the mannequin new plan additionally expands eligibility for Kaiser Permanente plans to Medicare-Medicaid twin-eligibles, foster youths, these who fail to choose out a well being plan and are assigned one by default, and one other teams.

The nationwide Union of Healthcare workers has acknowledged that any progress of Kaiser Permanente’s Medi-Cal presence should be delayed till the agency enters proper into a binding settlement with the state remedy its behavioral well being shortfall. better than 2,000 Kaiser Permanente psychological well being workers went on strike in California this month after a 12 months of contract negotiations. The union staff had been working with no contract since September. 

The California division of Managed well being Care is conducting “a non-routine survey” of Kaiser Permanente’s psychological healthcare companies in response to an uptick in shopper complaints, Director Mary Watanabe instructed legislators this month.

Sourcelink

Comments