Medi-Cal Managed Care Program Fact Sheet

1 Medi-Cal Managed care Program FACT Sheet - Managed care Models County Organized Health Systems Geographic Managed care (GMC) Two-Plan (COHS). Model Description: Model Description: Model Description: In a COHS Model county, the Medi- In a GMC Model DHCS contracts with In a Two-Plan Model county, there is a Cal Managed care health plan is run multiple Knox-Keene Act licensed county organized plan called the Local by the county. In a COHS county, commercial health plans within a Initiative (a prepaid health plan) and a there is only one Managed care plan single county. The GMC Model commercial plan. The Local Initiative serving the Medi-Cal population. serves clearly defined geographic plan is a Knox-Keene Act licensed, areas. county sponsored Managed care plan Required Steps: that serves one or more counties.

2 Required Steps: DHCS contracts with both plans for The county Board of Supervisors the delivery of Medi-Cal Managed (BOS) may establish, by ordinance, a In a GMC Model county, interested care services in the county. commission to negotiate a COHS health plans are required to participate contract with DHCS. The commission in DHCS' procurement process. Such serves as an independent oversight a procurement process would be open Required Steps: entity for the delivery of Medi-Cal to all eligible organizations that can In the Two-Plan Model counties, Managed care services in that county. meet qualification requirements. This interested counties must establish a COHS contracts may be on a non-bid process may result in one or more Local Initiative by county ordinance.

3 Basis and exempt from Chp. 2 of Part health plan contracting with DHCS. Interested commercial plans must 2 of the Public Contract Code. compete for a contract through DHCS'. procurement process. Legal References: Legal References: Assembly Bill 336, Chapter 95, Article , Chp. 7, Part 3, Div. 9 of the Statutes of 1991 and Senate Bill 485, Legal References: Welfare & Institutions Code Chapter 722, Statutes of 1992 Prepaid Plans, Chp. 8, Part 3, Div. 9. Article , Chp. 7, Part 3, Div. of the of the Welfare & Institutions Code Welfare & Institutions Code California Code of Regulations, Title California Code of Regulations, Title 22, Section 53800 et. Seq. 22, Sections 53900-53928. Medi-Cal Managed care Program FACT Sheet - Managed care Models Regional Imperial San Benito Model Description: Model Description: Model Description: Rural counties that have not elected to The Imperial Model originated out of The San Benito Model also originated participate as a COHS model or as the Regional Model to serve rural out of the Regional Model to serve the Local Initiative of a Two-Plan expansion needs.

4 Similarly, in an rural expansion needs. In the San model can offer Medi-Cal Managed Imperial Model county, there are two Benito Model county, there is one care through the Regional Model. The Knox-Keene Act licensed commercial Knox-Keene Act licensed commercial Regional Model developed for the plans that contract with DHCS to plan that contracts with DHCS. rural expansion and consists of two serve one or more counties. Beneficiaries can choose the commercial health plans, that are Managed care plan or regular (fee-for- Knox-Keene Act licensed, wanting to service) Medi-Cal . Required Steps: serve two or more contiguous counties in the designated Expansion Commercial Plans interested in participating as an Imperial Model Required Steps: Region.

5 Plan must participate in a procurement Commercial Plans interested in process. Such a procurement process participating as an Imperial Model Required Steps: would be open to all eligible plan must participate in a procurement Commercial Plans interested in organizations that can meet process. Request for Application participating as a Regional Model plan qualification requirements, including (RFA). Such a procurement process must participate in a procurement commercial businesses, nonprofit would be open to all eligible process. Such a procurement process organizations, State or public organizations that can meet would be open to all eligible universities (including auxiliary qualification requirements, including organizations that can meet organizations) and other entities that commercial businesses, nonprofit qualification requirements, including are currently operating a Managed organizations, State or public commercial businesses, nonprofit care health plan.

6 Universities (including auxiliary organizations, State or public organizations) and other entities that universities (including auxiliary are currently operating a Managed Legal References: organizations) and other entities that care health plan. are currently operating a Managed Assembly Bill 1467, Chapter 23, care health plan. Statutes of 2012. Sections and of Legal References: the Welfare & Institutions Code Assembly Bill 1467, Chapter 23, Legal References: Statutes of 2012. Medi-Cal Managed care Program FACT Sheet - Managed care Models Regional Imperial San Benito Assembly Bill 1467, Chapter 23, Sections and of Statutes of 2012 the Welfare & Institutions Code Sections and of the Welfare & Institutions Code 1/2/2020.