health careMedi-Cal will keep more insurance plans after pushback
In a significant course change, the
This upends the state’s previous plans of awarding contracts to only three health plans. It means more
from insurers who had previously been left out.
The big winners:
“To bring certainty for members, providers and plans, the State used its authority to work directly with the plans to re-chart our partnership and move with confidence and speed toward the implementation of the changes we want to see,” the department wrote in a statement released Friday afternoon. The department did not provide answers to follow-up questions before publication.
“At some level it makes the transition easier, but we want to do better than the status quo,” said
In August of last year, the state announced that it would tentatively award
The state’s summer announcement quickly became controversial as health plans that were left out questioned the state’s process for choosing the three insurers, appealed the decision and sued the state.
This change of course calls into question the power that insurance companies can have in pressuring state action with legal threats. Health advocates say they hope it does not set a precedent. Wright at Health Access said he’d like for the department to make clear that the state is not backing away from the competitive contract process in the future, as he considers it is a key tool for accountability.
The insurance giant even launched a campaign in the fall asking Californians to speak out against the state’s decision. The company argued that the state failed to sufficiently engage
Under the revised agreement,
Meanwhile, Health Net, which in the summer was tentatively awarded contracts in nine counties but lost its previous and largest contract in
The splitting of members evenly between Molina and Health Net through a subcontracting agreement is a “step in the right direction,” said
“Who’s the 50 percent that are going to be able to stay with Health Net and who are the 50 percent that are going to have to move?” Mangia said. “We don’t have answers to that, so I think it’s problematic in that it still displaces a significant number of patients.”
Currently, Health Net manages more than 1 million
Mangia said the latest decision will still disrupt services for the 12,500 patients at St. John’s alone who will be forced to switch to Molina. He anticipates the clinic needing to hire more staff to help with patient navigation, but there’s no money for that.
“It was obviously an attempt to rectify the initial decision, but I’m not sure the impact on patients is going to be all that different. That’s my concern,” Mangia said. “It’s essentially an unfunded mandate.”
In discussing the decision, Zubretsky and CFO
“With that as the understanding, we thought it best for the company, for membership and for investors to participate in the negotiation,” Zubretsky said.
Molina has agreed not to protest the final contract award and will subcontract with Health Net in
“We’ve agreed to the membership allocations that the state has now articulated in addition to waiving other types of legal rights that one would normally have,” Zubretsky told investors.
“It’s really better for the
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