California's reversal on its Medicaid managed care contracts has left industry insiders and consumer advocates questioning if the state will stick to its intention to reform Medi-Cal, California Healthline reported Jan. 26.
In December, California's Department of Health Care Services said it would award Blue Shield of California Promise Health Plan and Community Health Group Partnership Plan managed care contracts in San Diego County, and granted Centene's Health Net and Blue Cross of California Health Plan contracts in additional counties.
The original contract decisions, made in August, selected just three payers to manage the state's Medicaid program, which covers more than 12 million.
The contract procurement process, a first for Medi-Cal, was meant to "redefine" how care is delivered to Medi-Cal beneficiaries, the healthcare services department said. The contracts were part of the state's wider-reaching efforts to improve care delivery and equity in Medicaid.
The concessions states struck with health plans left some advocates questioning if the contract procurement process was valuable and if the state will enforce the equity and performance standards it set out in the contract, California Healthline reported.
"It would be extremely disappointing if poor-performing plans were able to litigate their way into participating in Medi-Cal," Abbi Coursolle, a senior attorney in the Los Angeles office of the National Health Law Program, told California Healthline.
Mark Ghaly, MD, secretary of the California Health and Human Services Agency, told California Healthline lawsuits and litigation introduced uncertainty into the process. The state feels it has "achieved certainty" with the current contract arrangement, Dr. Ghaly said.
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