Out of approximately one million people with disabilities enrolled in California’s Medi-Cal program, only 20 percent are enrolled in managed care. In January 2005, Governor Schwarzenegger proposed expanding mandatory managed care for people with disabilities. The California HealthCare Foundation (CHCF) recognized the Governor’s proposal as an opportunity to foster a constructive dialogue among health plan representatives and consumer advocates, to improve the quality of care for people with disabilities and chronic conditions, and to establish better methods of measuring and monitoring health plan performance.
CHCF contracted with the Center for Health Care Strategies, the Center for Disability Issues and the Health Professions at Western University of the Health Sciences, and The Lewin Group to work together to develop a set of performance standards and measures for health plans serving people with disabilities in Medi-Cal.
This ensuing report outlines a set of recommended health plan performance standards and measures that can improve how people with disabilities and chronic conditions receive services through the Medi-Cal managed care program. The recommendations provide an essential tool for California policy makers and program officials to ensure that Medi-Cal funds are spent efficiently and that limited state resources are used most effectively. Other states considering expansions of managed care for SSI populations can gain valuable guidance from this comprehensive set of recommendations.