Senate Convenes Informational Hearing on Health Plan Oversight and CalAIM

On Wednesday, the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services and the Senate Health Committee convened a joint hearing to discuss oversight and accountability of Medi-Cal managed care plans and new responsibilities for health plans included in CalAIM.

Dr. Bradley Gilbert began serving as director of the Department of Health Care Services (DHCS) this week and was joined by Jacey Cooper, State Medicaid Director and Chief Deputy Director of Health Care Programs to provide a presentation on DHCS oversight and accountability of health plans for part 1 of the hearing. Dr. Gilbert briefly highlighted his previous experience as a physician who has treated patients in jail settings, methadone clinics and has cared for the most vulnerable populations. He also noted his previous experience as a Public Health Officer in two counties and his experience as Chief Medical Officer and most recently Chief Executive Officer of Inland Empire Health Plan. He expressed his excitement about the potential CalAIM brings and acknowledged the work ahead for both the department and health plans.

Jacey Cooper discussed the various ways in which the department provides oversight and monitoring of health plans. She also laid out the department’s plan for the upcoming procurement for commercial plans in 36 counties. She indicated the department will be looking for plans that have a history of providing high quality care and that can ensure an adequate network and focus on preventive and early intervention services. In terms of timeline, Ms. Cooper announced the department would host a stakeholder webinar in April to solicit initial feedback on the procurement and areas of focus, followed by a 30-day comment period. In December, the department will be releasing a draft request for proposals (RFP) with another 30-day comment period. The official RFP would be released in June 2021, proposals would be due in August and contracts would be awarded in December/January 2022.

The following panels featured health plan representatives and Medi-Cal providers and consumers. The health plans shared details about the members they serve, local partnerships and investments and/or grant programs offered to their communities. Committee members inquired about barriers to ensuring adequate networks. Representing Medi-Cal providers, the California Medical Association discussed the added complexity with delegated entities, while the San Francisco Community Clinic Consortium discussed data challenges and the need to receive timely and useful data. On the consumer end, the California Pan Ethnic Health Network raised the need to ensure disparities in access to care and health outcomes are addressed and Children Now expressed the need to ensure children are accessing the recommended preventative services.

The second part of the hearing focused on CalAIM. Jacey Cooper walked the joint committee through key aspects of the initiative to transform Medi-Cal. A panel of county providers, consumers and plans followed. The California Association of Public Hospitals and Health Systems (CAPH) discussed CalAIM opportunities and areas of concern, including the voluntary nature of in-lieu-of services (ILOS), limitations on supplemental payments that can be accessed, and external political environment at the federal level. Service Employees International Union (SEIU) discussed the role and value of county workers and the impact of CalAIM on the county workforce. Anthem Blue Cross expressed their interest and excitement for CalAIM and noted intent to continue close collaboration with counties to leverage and/or expand the existing infrastructure to provide services. Finally, the Local Health Plans of California (LHPC), also excited about CalAIM opportunities, highlighted four vital areas to ensure success: 1) strong relationships [with counties]; 2) building from existing services and infrastructure; 3) maximizing incentives to expand ILOS; and 4) continued DHCS leadership – including policy guidance and timely rates.

For additional information regarding the hearing, please refer to the agenda and/or recording of the hearing.