At publication time, 52% of Medi-Cal beneficiaries are enrolled in some form of managed care, and 26 counties enroll some or all Medi-Cal beneficiaries in managed care programs.
At publication time, 52% of Medi-Cal beneficiaries are enrolled in some form of managed care, and 26 counties enroll some or all Medi-Cal beneficiaries in managed care programs. This fact sheet describes Medi-Cal managed care and the various models under which it operates.
There are three main Medi-Cal managed care models in California: County Organized Health Systems, Geographic Managed Care, and the Two-Plan Model. There are also a limited number of prepaid health plans and primary care case management programs that enroll Medi-Cal recipients on a voluntary basis. A small number of state-approved special managed care projects also exist primarily to serve seniors and individuals with AIDS.
Medi-Cal beneficiaries are enrolled in managed care according to the model of managed care in their given county. With the exception of those beneficiaries living in areas with a County Organized Health System, enrollment in a managed care plan is a process independent from general enrollment into the Medi-Cal program. A state subcontractor, Maximus, is responsible for both informing Medi-Cal beneficiaries about the managed care process and administering enrollment.
The complete fact sheet is available under Document Downloads.