Over 80% of all those in Medi-Cal (more than 10 million Californians) are enrolled in a managed care plan. Variation in quality and access across plans, and by other factors such as race and ethnicity, means some enrollees are much more likely than others to get life-saving preventive care or essential treatment for chronic conditions.

In 2021 the California Department of Health Care Services (DHCS) will begin the process of recontracting with Medi-Cal managed care plans (often referred to as procurement) and will also update its Comprehensive Quality Strategy. These are critical opportunities to use new financial incentives and oversight measures to improve quality and access to care for Medi-Cal members.

This collection highlights research into the quality of care in Medi-Cal managed care and potential solutions that can be pursued by DHCS.

CHCF Blog

Six Things to Watch For Now That Medi-Cal Has Picked Commercial Managed Care Plans

September 8, 2022
Christopher Perrone
Health Equity, Medi-Cal
Continued investment and sound implementation will lead to higher quality care for millions of Medi-Cal enrollees — and progress toward reducing racial and ethnic disparities in outcomes.
CHCF Blog

Medi-Cal Quality Strategy Explores Bold Steps Toward Health Equity

January 26, 2022
Christopher Perrone
Health Equity
The strategy will shape how health care will be provided to almost one in three Californians.
Publication

Organizations React to Medi-Cal Managed Care Procurement Request for Proposals

September 2021
Bailit Health
Medi-Cal, Health Equity
In June DHCS issued a draft RFP for the first-ever statewide procurement for commercial Medi-Cal managed care plans. CHCF asked organizations to share the comments they submitted to the agency about the RFP. This report presents common themes from across those shared comments.
August 5, 2021

Webinar — Organizations React to Medi-Cal Managed Care Procurement Draft RFP

Medi-Cal, Payment & Financing
August 5, 2021
CHCF’s webinar on August 5 from noon to 1:15 PM (PT) highlighted the feedback provided to DHCS from various organizations on the Medi-Cal managed care procurement draft RFP.

Organizations Share Their Comments to DHCS on Medi-Cal Managed Care Procurement RFP

Explore various organizations' comments to DHCS on the draft RFP for the upcoming reprocurement of commercial Medi-Cal managed care plans.
CHCF Blog

Health Disparities Require Bolder Action on Medi-Cal Managed Care Contracts

June 24, 2021
Christopher Perrone
Health Equity, Medi-Cal, Payment & Financing
The draft RFP for Medi-Cal managed care procurement is a significant step forward, but California must do more to eliminate disparities in access and outcomes
Publication

Medi-Cal Explained: Managed Care Plan Procurement

May 2021
Mari Cantwell, Sarah Brooks
Medi-Cal, Payment & Financing
This brief explains what the 2021 Medi-Cal managed care reprocurement process is and what it means for millions of Californians served by Medi-Cal.
CHCF Blog

A Golden Opportunity to Narrow California’s Racial Health Disparities

April 12, 2021
The Los Angeles Times Editorial Board
Medi-Cal, Payment & Financing
The state now has a rare opportunity to force health insurers to do more to improve the care that people with low incomes receive through Medi-Cal.
CHCF Blog

Medi-Cal: California Has a Rare Opportunity to Improve Health Care Equity

March 26, 2021
Sandra R. Hernández
Medi-Cal, Payment & Financing
About 10 million Californians get their health care through a Medi-Cal managed care plan, but the state's contracts with those plans fail to ensure that these enrollees get the high-quality care they deserve.
Publication

Paying Medi-Cal Managed Care Plans for Value: Design Recommendations for a Quality Incentive Program

January 2021
Bailit Health
Medi-Cal, Payment & Financing
This report recommends a new way to pay Medi-Cal managed care plans (MCPs) designed to improve the quality of care for Medi-Cal enrollees. The Department of Health Care Services would withhold part of its capitation payments to MCPs, who could earn back some or all of the amount withheld depending on their performance on quality measures.
CHCF Blog

Use ‘Carrots and Sticks’ to Spur Better Quality, Equity From Medi-Cal Managed Care Plans

February 4, 2021
Christopher Perrone
Medi-Cal, Payment & Financing, Health Equity
California has a rare opportunity to institute long-overdue financial incentives tied to health plan performance.
CHCF Blog

State Must Write New Medi-Cal Contracts to Advance Health Equity

January 20, 2021
Anne Sunderland
Health Equity, Medi-Cal
An interview with Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network.
Project

Health Organizations Advise DHCS on Recontracting with Medi-Cal Health Plans

Medi-Cal
On September 1, 2020, the California Department of Health Care Services (DHCS) requested input on proposed changes to Medi-Cal managed care contracts. CHCF has collected various health organizations' responses, as they collectively reflect important thinking on how DHCS can recontract with health plans in a way that advances several critical improvements to Medi-Cal managed care.
External Resource

Medi-Cal’s System for Children’s Health Care Is Broken; Newsom Can Help Fix It

In this CalMatters commentary, Children Now recommends how the Newsom Administration can re-contract with Medi-Cal managed care plans to improve quality and access for the state’s children enrolled in Medi-Cal.
External Resource

Children’s Medi-Cal Managed Care in California Counties

There is wide variation across the state and even within counties in managed care plan success in ensuring children get the services they need to get or stay healthy. Children Now analyzed county- and plan-level data to develop 58 county landscapes of Medi-Cal managed care for children.
Publication

A Close Look at Medi-Cal Managed Care: Quality, Access, and the Provider’s Experience Under Geographic Managed Care

October 2019
Blue Sky Consulting Group
Medi-Cal
This report explores quality of care, access to care, and patient satisfaction for Medi-Cal enrollees in counties that use the Geographic Managed Care Model, which uses five or more Medi-Cal managed care plans (MCPs) to deliver services. Results are compared to similar urban counties that rely on only one or two MCPs.
Publication

A Close Look at Medi-Cal Managed Care: Quality, Access, and the Provider’s Experience Under the Regional Model

October 2019
Blue Sky Consulting Group
Medi-Cal
Medi-Cal enrollees in 18 rural counties in California receive care under Medi-Cal’s Regional Model of managed care. This report compares access to care, quality of care, and both patients’ and providers’ satisfaction in Regional Model counties with other rural counties across the state.
Publication

A Close Look at Medi-Cal Managed Care: Statewide Quality Trends from the Last Decade

September 2019
Philip R. Lee Institute for Health Policy Studies at UCSF
Medi-Cal
This report examines the quality of care provided by Medi-Cal managed care plans between 2009 and 2018. In addition to reporting on overall trends in performance, this report also examines differences by type of ownership (public, nonprofit, for-profit) and model of managed care.
Publication

A Close Look at Medi-Cal Managed Care: Stories of Quality Improvement Success

September 2019
Athena Chapman, Caroline Davis
Medi-Cal
This paper highlights examples of Medi-Cal managed care plans that have made significant progress on individual quality-of-care measures. The paper identifies several common, interconnected strategies that were key to improving quality and provides concrete examples of how plans put these strategies into place.
CHCF Blog

New Study Shows Lagging Quality Improvement in Medi-Cal Managed Care

September 25, 2019
Christopher Perrone
Medi-Cal
Over the last decade, California hasn't seen the level of quality improvement expected from Medi-Cal, one of the state's most important programs.
Publication

California Map: Quality in Medi-Cal Managed Care, County by County

September 2019
Medi-Cal
Use this interactive map to learn more about the quality of care provided by local Medi-Cal managed care plans in your area between 2009 and 2018.
Publication

Accountability in the Medi-Cal Managed Care Program

April 2019
Medi-Cal
This fact sheet provides an overview of how the Department of Health Care Services assesses quality of care provided by the more than 30 full-service and specialty managed care plans that participate in Medi-Cal's managed care program.
Publication

Paying Medi-Cal Managed Care Plans for Value

April 2019
Bailit Health
Medi-Cal
Many states use financial incentives tied to quality of care and other measures of performance in their Medicaid managed care programs. This paper outlines a measure set and performance evaluation methodology that California could use as part of a financial incentive program to drive quality improvement in Medi-Cal managed care.
Publication

How California Can Use Purchasing Power and Oversight to Improve Quality in Medi-Cal Managed Care

April 2019
Bailit Health
Medi-Cal, Payment & Financing
This paper recommends how the California Department of Health Care Services can strengthen its purchasing strategy and oversight to drive quality improvement in Medi-Cal managed care.
April 29, 2019

Briefing — Improving Quality in Medi-Cal Managed Care

April 29, 2019
Join CHCF for a briefing on how California can improve quality and access within Medi-Cal managed care.
Publication

It’s Time to Pay Medi-Cal Plans Differently

March 2019
Medi-Cal, Payment & Financing
On February 27, 2019, Chris Perrone, director of Improving Access at CHCF, testified before the California Senate Committee on Health during an informational hearing on "Improving Performance and Aligning Incentives in Commercial Health Insurance and Medi-Cal." Read his testimony.
Publication

Making Quality Matter in Medi-Cal Managed Care

February 2019
Bailit Health
Medi-Cal
This report describes approaches many states are taking to use financial incentives with Medicaid managed care plans to accelerate quality improvements. There is an opportunity to build on current quality improvement efforts in Medi-Cal managed care, led by the California Department of Health Care Services, through financial incentives.
CHCF Blog

For Better Outcomes and Significant Savings, Medi-Cal Must Pay Health Plans Differently

April 4, 2018
Christopher Perrone
Medi-Cal, Payment & Financing
California can strengthen its use of payment as a tool to drive performance improvements and create greater value in the Medi-Cal program, and to enhance care for Medi-Cal's more than 13 million members.
Publication

Intended Consequences: Modernizing Medi-Cal Rate Setting to Improve Health and Manage Costs

April 2018
Manatt Health, Optumas Healthcare
Medi-Cal, Payment & Financing
The current Medi-Cal rate-setting methodology can hurt health plans that invest in initiatives that lower costs (such as care coordination), thereby discouraging more plans from making those investments. A new rate-setting methodology is needed.