Still '2 steps ahead': 5 reactions to California's Medi-Cal contract shuffle

More payers won coveted Medicaid managed contracts when California reversed course on its August decision to award just three payers contracts to run its Medicaid program. The state announced a revised decision Dec. 30, granting more payers contracts. 

The decision means more Medi-Cal recipients can keep their current health insurance provider, but still leaves confusion, some providers said. 

Here's what five payer and provider leaders had to say about the decision: 

Centene CEO Sarah London  said she was "pleased" with the decision to award the payer's subsidiary Health Net additional Medicaid contracts, including a 50 percent split with Molina Healthcare in Los Angeles County. 

"We believe their decision is in the best interest of millions of members, and we look forward to working with [the California Department of Health Care Services] to address health disparities and improve how healthcare is delivered to Medi-Cal members across the state," Ms. London said in a news release. 

Health Net has dropped its legal challenges related to the decision. 

 

Molina Healthcare CEO Joe Zubretsky told investors on a Jan. 3 call that though the company will have fewer Medicaid members in California than in the August announcement, the revised award still doubles the payers' Medicaid presence in the state. 

"Had this new result been the one originally awarded [in August,] I can honestly say we would be nearly as thrilled in that outcome as we were with the original outcome," Mr. Zubretsky told investors. 

Molina Healthcare won big in the original contract awards but will now split its membership 50/50 with Health Net in Los Angeles County, the state's largest county. 

The company revised its expected earnings from the California contracts to $3.9 billion, down from $5.5 billion. 

"The overall situation with respect to the California Medicaid awards can be summarized as taking three steps forward, taking one step back, and ending up being two steps ahead," Mr. Zubretsky said. 


Jim Mangia, CEO of St. John's Community Health
, said fewer disruptions for patients is good. Mr. Mangia, who leads a health system that treats low-income patients in Los Angeles, told CalMatters Jan. 4 the 50/50 split between Health Net and Molina in Los Angeles county could cause confusion for patients and providers. 

"Who's the 50 percent that are going to be able to stay with Health Net and who are the 50 percent that are going to have to move?. We don't have answers to that, so I think it's problematic in that it still displaces a significant number of patients," Mr. Mangia told CalMatters. 

 

Blue Shield Promise CEO Kristen Cerf said the Blue Shield of California plan is "honored" to win back contracts in San Diego county. 

"We look forward to working with state and county officials, community leaders, and providers in our combined efforts to transform Medi-Cal through California Advancing and​ Innovating Medi-Cal and bring access to quality healthcare to all Californians who need this vital program," Ms. Cerf said in a news release. 

The payer, which lost contracts in all 13 counties in which it bid in the original decisions, launched a legal challenge and marketing campaign against the state. 

The payer's website, standupforhealthcare.com, which encouraged residents to contact California Gov. Gavin Newsom's office about the contracts, has been set to private as of Jan. 5. 

 

Zara Marselian, PhD, CEO of La Maestra Community Health Centers in San Diego said the decision to award contracts to Community Health Group in San Diego county is welcome news for Medi-Cal patients who will no longer have to switch providers. 

"It's really better for the Medi-Cal recipients that will not now have to transfer to another health plan and have their whole continuity of care disrupted," Dr. Marselian told CalMatters. "I'm really grateful however this happened. I'm really grateful on behalf of our patients."


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