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Health and Human Services Agency recommending the Board:
1) Receive and file a presentation on the current Regional Medi-Cal Managed Care Two-Plan model (commercial), and proposed changes thereto;
2) Approve and authorize the Chair to sign a Letter of Intent to transition to the established Health Plan of San Joaquin Local Initiative Two-Plan public/commercial Medi-Cal Managed Care Plan model.
FUNDING: There are no funding requirements related to County operations or associated activities.
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DISCUSSION / BACKGROUND:
California’s Medicaid program, Medi-Cal, is the largest state Medicaid program in the nation. Insuring almost one-third of California’s roughly 40 million residents, Medi-Cal is a key source of health coverage for low-income children, adults, and people with disabilities, while also providing wrap-around coverage for many elderly Medicare beneficiaries. California was the first state to pilot managed care in Medicaid, beginning in the early 1970s, and from that the Medi-Cal Managed Care (MMC) program has developed a unique structure that grew out of the different health care delivery and financing systems in different counties of the state. Over time, California has transitioned progressively more Medi-Cal beneficiaries into MMC, and through this Medi-Cal providers who wish to provide services to managed care enrollees must participate in the managed care plan’s provider network. A distinguishing feature of the MMC program is that different managed care models operate in different counties, largely shaped by the historical role of the counties in the financing and delivery of primary care, public hospital services, mental health services, and certain long-term services and supports to low-income and medically indigent residents. Today, in total, six different managed care models operate across California’s 58 counties: County Organized Health System (COHS), Two-Plan Model, Geographic Managed Care (GMC), Regional Expansion Model, Im...
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