Join for Free

X

ONECare Population Health Academy – Join For Free

"*" indicates required fields

Already a member of the OPEN MINDS network? Click here to login.
Name*
Address*
Consent*
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
This field is hidden when viewing the form
This field is hidden when viewing the form

X

Oops! You need to be logged in to use this form.

California Medicaid Announces New Direct Contract With Kaiser Permanente

|

By OPEN MINDS Circle

On February 4, 2022, the California Department of Health Care Services (DHCS) announced that it planned to enter into a direct contract with Kaiser Permanente as a Medi-Cal managed care plan within new geographic regions of the state. Kaiser Permanente currently participates in Medi-Cal managed care in 22 counties, and in 10 more counties Kaiser has another line of business. The new contract extends the Kaiser Permanente Medicaid coverage to these 32 counties.

Kaiser Permanente currently serves 900,000 Medi-Cal beneficiaries as a managed care plan subcontractor in 17 counties. It has two direct Geographic Managed care contracts that cover Sacramento, San Diego, Amador, El Dorado, and Placer counties. In 10 more counties Kaiser has another line of business, but does not currently enroll Medicaid beneficiaries, people dually eligible for Medicare and Medi-Cal, or foster youth.

The new contract with Kaiser Permanente would begin January 1, 2024, and run for a five-year contract term, with potential contract extensions. Under the new contracts, Kaiser will operate as a full-risk, full scope Medi-Cal managed care plan in the 32 counties where it currently has a presence, with no specific exceptions or alternative standards. However, members will not be able to enroll through the traditional Medi-Cal plan choice methods. Rather, in the 22 counties where it currently serves Medi-Cal beneficiaries, those existing members will have the choice to remain with the Kaiser plan or switch to another plan. In the 10 counties where Kaiser has another line of business, Kaiser will operate a Medi-Cal plan to enroll members from another line of business who become eligible for Medi-Cal and who wish to remain within the Kaiser system.

DHCS announced the Kaiser contract prior to issuing a statewide request for proposals (RFP) for Medicaid managed care organization plans. The RFP was released on February 9, 2022. It sets requirements for enrollments that Kaiserā€™s current Medicaid plans in the 22 counties cannot meet due to limitations in Kaiserā€™s physical capacity and fixed geographic locations. In its announcement about the Kaiser contract, DHCS said the goal of this contract is to preserve member continuity; maintain quality outcomes, and reduce disparities. Because Kaiser is not able to participate in the procurement, without this contract Kaiser members in the five GMC counties would need to change health plans, and the Medi-Cal program would lose its highest quality plan, Kaiserā€™s integrated model, and Kaiserā€™s expertise.

DHCS released additional details in a notice ā€œCalifornia Medi-Cal Direct Contract With Kaiser Permanente – 2022-23 Governorā€™s Budget Proposal.ā€ Under the proposal, Kaiser would be subject to all terms of the new managed care contract as commercial plans selected through the RFP except it would not be open through the traditional Medi-Cal plan choice methods. Existing Kaiser Medi-Cal members will have the option to stay with Kaiser. Additionally, Kaiser will commit to increasing its Medi-Cal membership by 25% over the five-year contract. DHCS anticipates that this growth would take place as members exit other Kaiser lines of business where Kaiser has a physical network presence but not currently enrolling Medi-Cal beneficiaries, dual eligibles (those eligible for both Medicare and Medi-Cal), and foster youth.

The arrangement adds several new requirements that expand Kaiserā€™s services for Medi-Cal beneficiaries:

  • Implement the California Advancing and Innovating Medi-Cal (CalAIM) Medicaid waiver Enhanced Care Management (ECM) and Community Supports in a manner consistent with other Medi-Cal managed care plans.
  • Leverage more community presence with other provider organizations, and must not limit its CalAIM ECM and Community Supports to only Kaiser members.
  • Implement at least the same number of CalAIM Community Supports as other Medi-Cal managed care plans in its service area.
  • Help federally qualified health centers (FQHCs) across the state to implement a portfolio of population health management, social health, and practice transformation solutions to augment clinical outcomes for beneficiaries served by FQHCs.
  • Implement an eConsult system for specialty care in partnership with FQHCs across the state which should leverage Kaiserā€™s specialty care expertise.

Additionally, DHCS and Kaiser will identify the highest need specialties and geographic areas where Kaiser will provide, by Kaiser physicians, a limited number of in-person, ambulatory based, outpatient specialty care visits, and associated needs such as diagnostic testing and outpatient procedures for non-Kaiser members. These services may be provided at locations other than Kaiser facilities (for example at FQHCs). This arrangement is intended test models and partnerships to deliver specialty care and to leverage Kaiserā€™s clinical expertise and integrated model to support underserved areas.

For more information, contact:

  • Michelle Baass, Director, California Department of Health Care Services, Post Office Box 997413, Sacramento, California 95899; Email: dhcspress@dhcs.ca.gov; Website: https://www.dhcs.ca.gov/
  • Catherine Hernandez, Senior Vice President and Chief Communications Officer, Kaiser Permanente, One Kaiser Plaza, Oakland, California 94612; 510-271-5953; Email: National-Media-Relations@kp.org; Website: https://about.kaiserpermanente.org/