Medi-Cal is at a pivotal juncture. Started 50 years ago as a program for people receiving cash welfare assistance, Medi-Cal now provides health coverage to one in three Californians. Medi-Cal has brought coverage, care, and long-term services and supports to millions of Californians, but much work remains to improve quality of care, access to care, care coordination, and patient satisfaction.

The California Health Care Foundation retained Manatt Health to consider the state of the Medi-Cal program and potential pathways for the next chapter of delivery reform, focusing particularly on Medi-Cal managed care. Manatt conducted a landscape review and in-depth interviews with a diverse array of over 50 Medi-Cal stakeholders and thought leaders. The resulting report provides an overview of Medi-Cal, assesses key challenges and opportunities, establishes a vision for delivery system reform, and articulates a path to achieve that vision. Key findings include:

• Overall, there is strong agreement with a vision for Medi-Cal, as expressed in the Medi-Cal 2020 waiver, to foster “shared accountability among all providers to achieve high-value, high-quality, and whole-person care.”
• Key barriers to achieving this vision include fragmented administration and delivery of care, fragmented financing, uneven access to providers, workforce challenges, lack of transparency and effective accountability mechanisms, and underresourced program management.
• There are near-term reforms that can be started now, including reforming how capitation rates are set for Medi-Cal managed care plans, intensifying efforts to coordinate care for people with serious mental illness, addressing workforce shortages, and more.
• In parallel to these important initiatives, a far more ambitious, longer-term agenda is needed to restructure and transform the underlying Medi-Cal delivery and payment system.

The complete report is available as a Document Download. The accompanying landscape assessment provides an overview of how Medi-Cal operates, is financed, and performs, as well as some insight into people who use the program.

Chris Perrone, director of Improving Access at CHCF, sat down with Cindy Mann, partner at Mannatt Health and former director of the federal Center for Medicaid and CHIP Services, after a Sacramento briefing on the report’s findings. They discussed how Medi-Cal compares to other state Medicaid programs and the opportunities for reform. The video below captures highlights from their conversation.