Gettysburg, Pa. (April 7, 2019) – OPEN MINDS has released an updated suite of Medicaid market intelligence resources on the state of California. The resources include analysis of the California Medicaid system, Medicaid managed care vendor contracts, and additional state-specific information.
California calls its state Medicaid program Medi-Cal. The state provides Medicaid managed care through six different models. Each county is able to choose one of the six models.
- County Organized Health System (COHS)
- In this model, health plans are created by one or more County Boards of Supervisors. The COHS plan is the only available Medicaid plan in the designated county or region and all Medi-Cal beneficiaries are enrolled in the plan, with the exception of partial benefit dual eligibles.
- Six health plans serve the 22 counties that utilize this model. The counties include: Del Norte, Humbolt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, Yolo.
- Contracts for the six health plans operating in the COHS program are available for download to all Elite OPEN MINDS Circle members:
- Geographic Managed Care (GMC) System
- In this model, the county and the state Department of Health Care Services (DHCS) contract with two or more commercial health plans. Enrollees pick the plan that best meets their needs.
- Eight health plans serve the two counties (Sacramento and San Diego) that utilize this model.
- Contracts for the six of the eight health plans operating in the GMC program are available for download to all Elite OPEN MINDS Circle members:
- Imperial County System
- Regional System
- In this model, DHCS contracts with two commercial health plans for the entire region, and three counties offer a third health plan to provide continuity of care from the managed care transition in 2013.
- These health plans serve 18 counties that were part of the 2013 Medicaid managed care expansion. These counties include: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne, Yuba.
- Contracts for the three health plans operating in the Regional System model are available for download to all Elite OPEN MINDS Circle members:
- San Benito County System
- San Benito County offers only one health plan; therefore all Medi-Cal recipients also have the option to receive services through the fee-for-service delivery system.
- The contract for the health plan operating in the San Benito program model is available for download to all Elite OPEN MINDS Circle members: Anthem Blue Cross
- Two Plan System
- The Two Plan System is a hybrid model where the county operates one health plan and contracts with a commercial health plan to offer a second option.
- Twelve health plans serve the 14 counties that utilize this model. The counties include: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stanislaus, Tulare.
- Contracts for the twelve health plans operating in the Two Plan System model are available for download to all Elite OPEN MINDS Circle members:
The California Medicaid Managed Care Contracts are available now for all Elite OPEN MINDS Circle members. Individual contracts may be purchased in the OPEN MINDS shop for $1,500 each.
Additionally, the OPEN MINDS team has four in-depth profiles of the California state health system:
- California Health Care System Landscape: An OPEN MINDS State Profile, which provides information on each state’s largest health plans, Medicaid expansion policy, health insurance marketplace plans, demographics, population health insurance coverage by payer, and more.
- California Medicaid System: An OPEN MINDS State Profile, which provides a detailed exploration of each state’s Medicaid financing system, including a review of the managed care financing systems, largest health plans by enrollment, key players in the state Medicaid department, and plans for future system changes and contract reprocurements.
- California Behavioral Health System State Profile Report, which provides a comprehensive listing of behavioral health benefits in the state, care coordination programs related to behavioral health, and behavioral health subcontractors for health plans.
- California Medicaid/Medicare Dual Eligible System: An OPEN MINDS State Profile, which provides an overview of each state’s dual eligible financing system, as well as the largest Medicare health plans serving dual eligibles and details on new initiatives involving the dual eligible population.
The California suite of state profiles is now available now for the Elite OPEN MINDS Circle members. In addition, the OPEN MINDS team has a wealth of additional California-specific resources. A monthly OPEN MINDS market intelligence update is available to all health and human services executives. To sign up, OPEN MINDS Circle members should set their email preferences under the My Account Settings.
All of these resources, and more, are available as part of an OPEN MINDS Circle Elite membership. Membership includes unlimited organizational access to all OPEN MINDS content and databases, plus executive education events, and other exclusive Elite member benefits. Learn more about becoming an Elite OPEN MINDS Circle member online at www.openminds.com/elite.
For additional questions and inquiries, please contact Sarah C. Threnhauser, Executive Vice President, OPEN MINDS at 717-334-1329 or email@example.com.
ABOUT OPEN MINDS
OPEN MINDS is a national market intelligence and strategic advisory firm focused on the sectors of the health and human service field serving consumers with chronic conditions and complex support needs. Founded in 1987 and based in Gettysburg, Pennsylvania, the 175+ associates provide market insights and innovative management solutions designed to improve operational and strategic performance. Learn more at www.openminds.com.