The California Department of Health Care Services notified Centene’s Health Net of a corrective action plan and potential sanctions Aug. 25, according to a letter shared with Becker’s.
Health Net is ending the Assisted Living Facility Transitions service for Medi-Cal members, a health plan spokesperson confirmed to Becker’s Aug. 18. On Sept. 4, the company also confirmed its forthcoming sunset of the Personal Care and Homemaker Services Community Support. Health Net said both services will end Dec. 31.
Through the California Advancing and Innovating Medi-Cal initiative — a multiyear transformation plan for the state’s Medicaid program — Community Supports are optional services to address health-related social needs. The ALFT Community Support, for example, aims to bring members at home or in a nursing facility to an assisted living facility, keeping them in a community and preventing institutionalization.
The DHCS letter explained the corrective action plan resulted from compliance, patient care, provider network and continuity of care concerns. The sanctions could surpass $25,000 per affected member per day if compliance issues persist.
Health Net decided to extend contracts with relevant providers through the end of 2026, the insurer said Sept. 4. The extension aligns with a mandate in the corrective action plan.
“Given changing market conditions and after discussions with DHCS, Health Net is extending its contracts with ALFT and PCHS Community Supports providers through Dec. 31, 2026,” a spokesperson said. “Health Net remains a strong supporter of CalAIM and Community Supports. As Community Supports mature, we will continue evaluating our experience and available data to prioritize services that produce better health outcomes and are consistent with the program’s objectives.”
Health Net said it was an “early adopter” of all 14 original Community Supports.
“Based on several years of experience and data, our data shows that the Assisted Living Facility Transition Community Support has not led to better care or fulfilled the state’s goal of being a cost-effective alternative to services covered under Medi-Cal, as measured by fewer ER visits and days in the hospital when compared to a control group of similar members who did not use the optional service,” the spokesperson said in the Aug. 18 statement.
Health Net said Aug. 18 that it is working with members, care management teams, providers and the state to establish personalized transition plans, as well as determine eligibility for other programs. Eligible members can still receive the service through their current authorization period.
The insurer did not respond to a question about how many people would be affected, but CalMatters reported Aug. 17 that approximately 3,500 Medi-Cal patients use Health Net to cover assisted living costs. CalViva Health and Community Health Plan of Imperial Valley also contract with Health Net.
Editor’s note: This story was originally published Aug. 18 and updated Sept. 11.
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