Six million Californians receive health care through the Medi-Cal managed care program. Over the past three years, the program has expanded to reach new populations, provide more services, and operate statewide. The program will expand further under the Affordable Care Act as those newly eligible for Medi-Cal, California's Medicaid program, are enrolled in managed care and as plans assume responsibility for additional covered services. With so much change to Medi-Cal managed care, interest in understanding how the program measures up has never been greater among state legislators, California Department of Health Care Services (DHCS) leadership, and the public.
Against this backdrop, the California HealthCare Foundation developed a performance dashboard for the Medi-Cal managed care program. Key indicators were selected that program officials, policymakers, consumer advocates, the media, and the public can use to quickly assess the overall performance of the program, identify areas of strength, and guide priorities for improvement. The dashboard is expected to expand as other measures become available.
Among the key findings:
- Medi-Cal managed care performs at or above the national Medicaid median on 17 of 19 quality indicators. On the two measures for which Medi-Cal lags behind the national median — postpartum care and timeliness of prenatal care — the gap has persisted over the last four years.
- On most measures of consumer experience, the program performs below the national Medicaid median.
- Across all measures of quality, access, and consumer satisfaction, there are considerable differences in performance among participating plans, including significant variation in plan performance within counties.
- Most plans participating in Medi-Cal appear to be in sound financial health. Two plans, however, have had net losses in each of the last two years.
Locally Sponsored Versus Commercial
Which type of Medi-Cal managed care plan does the best job caring for enrollees? A companion to the dashboard, Monitoring Performance: Locally Sponsored Versus Commercial Medi-Cal Plans provides an in-depth look at this particular aspect of Medi-Cal managed care.
The full report, as well as the companion issue brief, is available under Document Downloads.