Medi-Cal Win-Win: Surging Enrollment Fosters Investment in the Safety Net
December 10, 2015
Pacific Health Consulting Group
Policy and enrollment changes in 2013-2015 resulted in new relationships, opportunities, and pressures for Medi-Cal managed care plans and safety-net clinics. The data in this summary brief and accompanying report show that public plans and safety-net clinics are major players in Medi-Cal managed care. Almost 70% of beneficiaries were enrolled with public plans in 2015. Safety-net clinics’ share of overall enrollment rose from 33% in 2013 to 41% in 2015 — ranging from 7% to 70% of health plan membership, depending on geography.
The report documents financial support and targeted payments for safety-net clinics designed to support access and quality improvements. Public plans were far more likely than commercial plans to make investments in safety-net clinics and were more likely to pair payments with technical assistance.
Looking to the future, rate reductions, regulatory oversight, and practice reform imperatives may alter health plan investment in safety-net clinics. With few other sources of investment and capital, such changes would threaten safety-net viability at a time of significant need for the expanded Medi-Cal population.
The summary brief and the complete report are available as Document Downloads.