California Healthline: Auditor’s Report Shows ‘Symbiotic Relationship’ in Medi-Cal Managed Care

by David Gorn The seeming reluctance by state officials to closely monitor Medi-Cal managed care plans is troubling, said Gerald Kominski, director of the UCLA Center for Health Policy Research. Reacting to a June report from the California State Auditor’s office that criticized the Department of Health Care Services for lax oversight of Medi-Cal managed care plans, … Continue reading

California Healthline: LAO Report: State Could Lose $1 Billion

by David Gorn California stands to lose about $1 billion in federal health care funding through potential elimination of the current managed care organization tax if the governor’s proposed revision of the tax is not approved by federal officials, according to a report issued last week by the state Legislative Analyst’s Office. The Feb. 12 LAO … Continue reading

California Healthline: Two UC Medical Centers Dropping Medi-Cal Managed Care Contract

by David Gorn Health Net and two University of California medical centers agreed to sever ties on a Medi-Cal managed care contract. As of Jan. 1, that means roughly 4,300 patients will need to find new providers. According to Health Net, letters announcing the change have been mailed to patients and they should be receiving … Continue reading

California Healthline: Rural Frail, Elderly Beneficiaries Being Shifted to Medicaid Managed Care Plans

by David Gorn This week, state health officials launched a new phase in the rural expansion of Medi-Cal managed care, moving about 24,000 medically complicated seniors and the disabled into managed care plans. Coincidentally, the annual conference of the California State Rural Health Association convenes on Wednesday in Sacramento. The transition of seniors and persons … Continue reading

SJ Mercury News: California’s managed care project for poor seniors and disabled faces backlash

By Anna Gorman California’s experiment aimed at moving almost 500,000 low-income seniors and people with disabilities automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance. Many beneficiaries have received stacks of paperwork they don’t understand. Some have been mistakenly shifted to the new … Continue reading

NSCLC: What’s In A Notice? How Notices Of Action Protect Consumers In Medicaid Managed Long-Term Services And Supports

From our colleagues at NSCLC:  As Managed Long Term Services and Supports (MLTSS) rolls out nationwide, advocates on the ground have seen due process violations in appeals and notices of action. In this tool for advocates and consumers, NSCLC focuses on notice and appeal rights in MLTSS.  NSCLC provides background information on notices of action, … Continue reading

California Healthline: Fragile, Rural Population About To Be Moved Into Medi-Cal Managed Care

by David Gorn Next month, state health officials will launch a transition of rural Medi-Cal beneficiaries into Medi-Cal managed care health plans. Medi-Cal is California’s Medicaid program. The transition involves about 20,000 of the most frail and elderly segment of the rural Medi-Cal population — seniors and persons with disabilities, known as SPDs. “Most of … Continue reading

California Healthline: State Gearing Up To Move Rural Seniors, Disabled Into Medi-Cal Managed Care

by David Gorn Roughly one month from now, the state is launching a program to shift a new set of Medi-Cal beneficiaries into Medi-Cal managed care plans. This time, the state is focusing on a shift in care for some of the frailest patients in rural counties. On Dec. 1, about 20,000 Medi-Cal seniors and … Continue reading

Payers & Providers: DMHC Fining More Reluctant Payers

By Ron Shinkman Moves Toward Record Number of Penalties For Late Claims For years, health plans in California have been required to pay providers in a timely manner for services that have been rendered. After a years-long lull, the agency regulating such payments has been issuing significant penalties and fines. The Department of Managed Health … Continue reading

California Healthline: Main Push in Duals Project Starts, L.A. County Launches Passive Enrollment

About 7,100 Californians signed up daily for private health insurance in the state's exchange during the first week of December, data show. (David McNew / Getty Images),0,5700327.story#ixzz2nNcmjrOg

by David Gorn On Thursday, California health officials launched the biggest phase of the Cal MediConnect duals demonstration project by beginning passive enrollment of dual eligibles in Los Angeles County. The duals demonstration project, also known as Cal MediConnect, is part of the state’s Coordinated Care Initiative. In a written statement, Department of Health Care Services … Continue reading

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