JUNE 2023 Medi-Cal Explained FACT SHEET Medi-Cal Explained: choose to receive their Medi-Cal managed care benefits directly through L.A. Care or Health 2024 Managed Care Net, or from one of their plan partners. Plans ● In Fresno, Kings, and Madera Counties, CalViva, a public plan, contracts with Health Net to carry out many health plan functions and Author: Ralph Silber responsibilities. ● In Imperial County, beginning in 2024, the Medi-Cal managed care plans are becoming an Community Health Plan of Imperial Valley, a even more critical part of the Medi-Cal landscape, new public plan, will contract with Health Net with increasing responsibility for new services and to carry out many health plan functions and management of new populations not previously responsibilities. part of managed care. In 2024, there will be major ● Statewide, beginning in 2024, Kaiser Permanente changes in many California counties as to which (Kaiser) will operate in 32 of California's 58 coun- Medi-Cal managed care plans operate there. ties under a single, direct Medi-Cal contract To help providers and other delivery system stake- with California's Department of Health Care holders understand the coming changes, this fact Services. Under this contract, Kaiser will enter these markets: Fresno, Imperial, Kings, Madera, sheet describes geographic changes as well as Mariposa, Santa Cruz, Stanislaus, Sutter, Tulare, some unique managed care arrangements. The information is organized in two ways: by county and by managed care plan. First, Table 1 lists California's 58 counties alphabetically and indicates which Medi-Cal managed care plans will operate in each county beginning in January 2024. It also indicates which counties will have a managed care plan either The California Health Care Foundation is an enter or exit operations in 2024. Second, Table 2 independent, nonprofit philanthropy that works lists managed care plans alphabetically and lists to improve the health care system so that all the counties each plan will operate in beginning in Californians have the care they need. We focus January 2024. especially on making sure the system works for Californians with low incomes and for communi- In addition to the geographic changes, there are ties who have traditionally faced some unique current and upcoming Medi-Cal the greatest barriers to care. managed care arrangements worth calling out: We partner with leaders across ● In Los Angeles County, L.A. Care Health Plan the health care safety net to subcontracts with Anthem Blue Cross and Blue ensure they have the data and Shield of California Promise Health Plan as plan resources to make care more partners. In addition, Health Net subcontracts just and to drive improvement with Molina Healthcare as a plan partner. Under in a complex system. a "plan partner" arrangement, members can For more information, visit www.chcf.org. California Health Care Foundation www.chcf.org | 1 JUNE 2023 and Yuba Counties. Kaiser already participates Of note, special enrollment criteria will apply in Medi-Cal in other counties through these two for Kaiser Permanente in all counties. For details approaches: please visit 2024 Medi-Cal Managed Care Plans on ■ Direct contract. Amador, El Dorado, Placer, the Department of Health Care Service website. Sacramento, and San Diego Counties. ■ Subcontractor to public plan. Alameda, Contra Costa, Kern, Los Angeles, Marin, Napa, Orange, Riverside, San Bernardino, San Francisco, San Joaquin, San Mateo, Santa Clara, Solano, Sonoma, Ventura, and Yolo Counties. Table 1. 2024 Medi-Cal Managed Care Plans and Counties of Operation, Alphabetical by County 2024 Plans County Public Plan* Other Plans Major Change† Alameda ■ Alameda Alliance ■ Kaiser Permanente ‹ Anthem Blue Cross - exiting for Health Alpine ■ Health Plan of San ■ Anthem Blue Cross ‹ California Health & Wellness - exiting Joaquin › Health Plan of San Joaquin - entering Amador ■ Anthem Blue Cross ■ Health Net ■ Kaiser Permanente Butte ■ Partnership ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering Calaveras ■ Anthem Blue Cross ■ Health Net Colusa ■ Partnership ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering Contra Costa ■ Contra Costa ■ Kaiser Permanente ‹ Anthem Blue Cross - exiting Health Plan Del Norte ■ Partnership HealthPlan of California El Dorado ■ Health Plan of San ■ Anthem Blue Cross ‹ California Health & Wellness - exiting Joaquin ■ Kaiser Permanente › Health Plan of San Joaquin - entering Fresno ■ CalViva Health‡ ■ Anthem Blue Cross › Kaiser Permanente - entering ■ Kaiser Permanente Glenn ■ Partnership ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering Humboldt ■ Partnership HealthPlan of California California Health Care Foundation www.chcf.org | 2 JUNE 2023 2024 Plans County Public Plan* Other Plans Major Change† Imperial ■ Community Health ■ Kaiser Permanente ‹ California Health & Wellness - exiting Plan of Imperial ‹ Molina Healthcare - exiting Valley** › Community Health Plan - entering › Kaiser Permanente - entering Inyo ■ Anthem Blue Cross ■ Health Net Kern ■ Kern Health ■ Anthem Blue Cross ‹ Health Net - exiting System ■ Kaiser Permanente › Anthem Blue Cross - entering Kings ■ CalViva Health‡ ■ Anthem Blue Cross › Kaiser Permanente - entering ■ Kaiser Permanente Lake ■ Partnership HealthPlan of California Lassen ■ Partnership HealthPlan of California Los Angeles ■ L.A. Care Health Direct: Plan ■ Health Net ■ Kaiser Permanente L.A. Care plan partners: ■ Anthem Blue Cross ■ Blue Shield of California Promise Health Plan Health Net plan partner: ■ Molina HealthCare Madera ■ CalViva Health ‡ ■ Anthem Blue Cross › Kaiser Permanente - entering ■ Kaiser Permanente Marin ■ Partnership ■ Kaiser Permanente HealthPlan of California Mariposa ■ Central California ■ Kaiser Permanente ‹ Anthem Blue Cross - exiting Alliance for Health ‹ California Health & Wellness - exiting › Central California Alliance - entering › Kaiser Permanente - entering Mendocino ■ Partnership HealthPlan of California Merced ■ Central California Alliance for Health Modoc ■ Partnership HealthPlan of California Mono ■ Anthem Blue Cross ■ Health Net Monterey ■ Central California Alliance for Health California Health Care Foundation www.chcf.org | 3 JUNE 2023 2024 Plans County Public Plan* Other Plans Major Change† Napa ■ Partnership ■ Kaiser Permanente HealthPlan of California Nevada ■ Partnership ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering Orange ■ CalOptima ■ Kaiser Permanente Placer ■ Partnership ■ Kaiser Permanente ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering Plumas ■ Partnership ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering Riverside ■ Inland Empire ■ Kaiser Permanente Health Plan ■ Molina Healthcare** Sacramento ■ Anthem Blue Cross ‹ Aetna - exiting ■ Health Net ■ Molina Healthcare ■ Kaiser Permanente San Benito ■ Central California ‹ Anthem Blue Cross - exiting Alliance for Health › Central California Alliance - entering San Bernardino ■ Inland Empire ■ Kaiser Permanente Health Plan ■ Molina Healthcare§ San Diego ■ Blue Shield of California ‹ Aetna - exiting Promise Health Plan ‹ Health Net - exiting ■ Community Health Group ■ Kaiser Permanente ■ Molina Healthcare San Francisco ■ San Francisco ■ Anthem Blue Cross Health Plan ■ Kaiser Permanente San Joaquin ■ Health Plan of San ■ Health Net Joaquin ■ Kaiser Permanente San Luis Obispo ■ CenCal San Mateo ■ Health Plan of San ■ Kaiser Permanente Mateo Santa Barbara ■ CenCal Santa Clara ■ Santa Clara Family ■ Anthem Blue Cross Health Plan ■ Kaiser Permanente Santa Cruz ■ Central California ■ Kaiser Permanente › Kaiser Permanente - entering Alliance for Health Shasta ■ Partnership HealthPlan of California Sierra ■ Partnership ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering California Health Care Foundation www.chcf.org | 4 JUNE 2023 2024 Plans County Public Plan* Other Plans Major Change† Siskiyou ■ Partnership HealthPlan of California Solano ■ Partnership ■ Kaiser Permanente HealthPlan of California Sonoma ■ Partnership ■ Kaiser Permanente HealthPlan of California Stanislaus ■ Health Plan of San ■ Health Net › Kaiser Permanente - entering Joaquin ■ Kaiser Permanente Sutter ■ Partnership ■ Kaiser Permanente ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Kaiser Permanente - entering › Partnership HealthPlan of California - entering Tehama ■ Partnership ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Partnership HealthPlan of California - entering Trinity ■ Partnership HealthPlan of California Tulare ■ Anthem Blue Cross › Kaiser Permanente - entering ■ Health Net ■ Kaiser Permanente Tuolumne ■ Anthem Blue Cross ■ Health Net Ventura ■ Gold Coast Health ■ Kaiser Permanente Plan Yolo ■ Partnership ■ Kaiser Permanente HealthPlan of California Yuba ■ Partnership ■ Kaiser Permanente ‹ Anthem Blue Cross - exiting HealthPlan of ‹ California Health & Wellness - exiting California › Kaiser Permanente - entering › Partnership HealthPlan of California - entering * In California there are public, nonprofit Medi-Cal managed care plans that are locally governed and publicly accountable. They were established in state statute and county ordinances to serve Medi-Cal enrollees and support the safety net. † A major change is defined as a managed care plan entering or exiting the county. (In 2024, certain counties will transition from California Health & Wellness to Health Net. However, because both these plans are Centene companies, this is not considered a major change.) ‡ CalViva Health contracts out many health plan functions and responsibilities to Health Net. Community Health Plan of the Imperial Valley will also contract out many functions to Health Net. ** Currently, Health Net is a plan partner with Molina in Riverside and San Bernardino Counties. This arrangement will end on January 1, 2024. Source: Author's review and analysis of 2023 California Department of Health Care Services Medi-Cal documents and interviews with Medi-Cal managed care key informants. California Health Care Foundation www.chcf.org | 5 JUNE 2023 Table 2. 2024 Medi-Cal Managed Care Plans and Counties of Operation, Alphabetical by Managed Care Plan Medi-Cal Managed Care Plan County Alameda Alliance for Health Alameda Anthem Blue Cross Direct: Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Madera, Mono, Sacramento, San Francisco, Santa Clara, Tulare, Tuolumne Plan partner with L.A. Care:* Los Angeles Blue Shield of California Promise Health Plan Direct: San Diego Plan partner with L.A. Care:* Los Angeles CalOptima Orange CalViva Health Contracts out most health plan functions to Health Net in: Fresno, Kings, Madera CenCal Health San Luis Obispo, Santa Barbara Central California Alliance for Health Mariposa, Merced, Monterey, San Benito, Santa Cruz Community Health Group San Diego Community Health Plan of Imperial Valley Contracts out most functions to Health Net in Imperial Contra Costa Health Plan Contra Costa Gold Coast Health Plan Ventura Health Plan of San Joaquin Alpine, El Dorado, San Joaquin, Stanislaus Health Plan of San Mateo San Mateo Health Net † Direct: Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne Subcontract: Fresno, Imperial, Kings, Madera Inland Empire Health Plan Riverside, San Bernadino Kaiser Permanente Alameda, Amador, Contra Costa, El Dorado, Fresno, Imperial, Kern, Kings, Los Angeles, Madera, Marin, Mariposa, Napa, Orange, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus, Sutter, Tulare, Ventura, Yolo, Yuba Kern Health Systems Kern L.A. Care Health Plan Los Angeles; delegates some membership to Anthem Blue Cross and Blue Shield of California Promise Health Plan Molina Healthcare Direct: Riverside, Sacramento, San Bernardino, San Diego Plan partner with Health Net:† Los Angeles Partnership HealthPlan of California Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Nevada, Placer, Plumas, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, Yuba San Francisco Health Plan San Francisco Santa Clara Family Health Plan Santa Clara * L.A. Care Health Plan subcontracts with Anthem Blue Cross and Blue Shield of California Promise Health Plan as plan partners. These plan partners are offered as an option to L.A. Care members and carry out many health plan functions and responsibilities for Medi-Cal enrollees who select them. However, unlike managed care plans with a direct arrangement, they are subcontractors and do not hold a contract with the Department of Health Care Services in Los Angeles County. † Health Net subcontracts with Molina as a plan partner in Los Angeles. This plan partner is offered as an option to Health Net members and carries out many health plan functions and responsibilities for Medi-Cal enrollees who select Molina. However, unlike a managed care plan with a direct arrangement, Molina is a subcontractor and does not hold a contract with the Department of Health Care Services in Los Angeles County. Source: Author's review and analysis of 2023 California Department of Health Care Services Medi-Cal documents and interviews with Medi-Cal managed care key informants. California Health Care Foundation www.chcf.org | 6 JUNE 2023 About the Authors Ralph Silber, MPH, is an independent consultant with more than forty years of experience in the community health center movement and an affiliate with El Cambio Consulting. He previously served as the CEO of the Alameda Health Consortium and the Community Health Center Network, a Medi-Cal managed care organization. El Cambio Consulting provides strategic guidance, analysis, and management consulting to safety net health care organizations in California that are rooted in their communities and committed to improving health outcomes through persever- ance and innovation. This includes community health centers, county public health agencies and departments, Medi-Cal managed care plans, social service providers and the foundations and associa- tions that support their work. Medi-Cal Explained is an ongoing series on Medi-Cal for those who are new to the program, as well as those who need a refresher. To see other publications in this series, visit www.chcf.org/MC-explained. California Health Care Foundation www.chcf.org | 7