As part of a broader effort to improve health care access and outcomes and reduce costs, California embarked on a year-long endeavor to move seniors and people with disabilities into Medi-Cal managed care coverage. The policy affected nearly 400,000 Medicaid beneficiaries, including 240,000 who were moved from fee-for-service into managed care between June 2011 and May 2012. The transition involved extensive collaboration among the California Department of Health Care Services (DHCS), health plans, providers, and consumer organizations.
Through this collaboration, DHCS adopted 23 new contract standards to ensure that health plans address the needs of non-elderly adults with disabilities. The identification of these new contract requirements were informed, in part, through an earlier project involving the California HealthCare Foundation and DHCS. Through this earlier effort, a multi-stakeholder advisory group and eight workgroups reviewed the state’s existing managed care contracts and the contracts of other state Medicaid programs to identify high-priority recommendations for performance standards.
This new report examines which of the high-priority recommendations were adopted in Medi-Cal’s new program as well as those that were not used. Through consultation with DHCS staff, the report outlines the rationale for contracting decisions, including areas where significant efforts are still underway to address recommendations. The report concludes with an examination of the implications of expanding managed care for individuals enrolled in both Medicare and Medicaid.
California’s experience in customizing performance measures for people with disabilities can help inform additional states looking to transition this population into managed care.