Santa Clara Family Health Plan is pushing back against Santa Clara County’s move to transition its Medi-Cal infrastructure to a “single plan” model, calling the move a “hostile takeover,” the Mercury News reported May 22.
Santa Clara Family Health Plan was created in 1995 as an independent entity to manage Medi-Cal services separate from the county. In an effort to streamline operations and boost reimbursement rates, the California county recently replaced most of the health plan’s governing board with county employees, which the insurer argues is in violation of state law.
The health plan filed a lawsuit in a county court to block the transition, but a judge rejected its request for a temporary restraining order.
“It disrespects our governing board, our staff and most importantly our members,” Family Health Plan CEO Christine Tomcalashe told county supervisors, per the news report. “These actions simply cannot be justified, not by promises of higher reimbursement rates or access to our reserves, and not by aspirations for a single plan county model. Because however desirable, none of these things can be accomplished without collaborating with Santa Clara Family Health Plan.”
“There’s really an urgent need for an efficient unified and effective Medi-Cal strategy that can mitigate these cumulative impacts and support the stability of these critical safety net services,” County Executive James Williams said, per the report. “Those run directly by our county organization, which again are the most significant in terms of volume and hospital care, but also community clinics and other critical Medi-Cal providers too.”
