Medi-Cal Managed Care and Long-Term Services and Supports: Opportunities and Considerations Under CalAIM
This report explores some design options for implementing MLTSS that policymakers, agency leaders, advocates, and other stakeholders can consider as this work unfolds.
Easing Transitions: CalAIM’s Changes for California’s Older Adults and People with Disabilities
CalAIM’s overarching goal is to streamline and create uniformity across the state and counties in services, eligibility, benefits, and delivery systems.
Medi-Cal Explained: What Are Alternative Payment Models?
Medi-Cal Explained: What Are Alternative Payment Models? explores how Medi-Cal has been developing alternative payment models to align with federal initiatives and state financial and policy goals. It looks at the benefits of these models and barriers to their adoption.
Medi-Cal Explained: How Health Centers Are Paid is about payment methods for community health centers and Federally Qualified Health Centers, including prospective payment system reimbursement.
CalAIM and Institutional Long-Term Care: Lessons for Medi-Cal Managed Care
CalAIM (California Advancing and Innovating Medi-Cal) is a comprehensive, multiyear effort led by the California Department of Health Care Services (DHCS) that seeks to implement broad delivery system, program, and payment reform across California’s Medi-Cal (Medicaid) program.
Meeting the Moment: Strengthening Managed Care’s Capacity to Serve California’s Seniors and Persons with Disabilities
Like their counterparts across the country, California’s Seniors and Persons with Disabilities (SPDs) face serious obstacles and challenges navigating fragmented systems of medical and long-term services and supports to get the care they need.
Getting to Care: A Look at Medi-Cal's Transportation Benefit
To improve access to care for Medi-Cal enrollees, state lawmakers significantly expanded transportation coverage in 2016.This report was commissioned to provide an overview of the implementation and experiences of the NMT benefit.
One in a series of the California Health Care Foundation’s Medi-Cal Explained, this fact sheet provides a high-level overview of the delivery of long-term services and supports (LTSS) in Medi-Cal. LTSS are benefits that support individuals who require assistance with activities of daily living such as bathing, dressing, eating.
CalOptima’s Strategic Plan offers guidance and sets priorities for the health plan to meet its mission and vision. CalOptima’s strategic plan focuses on how to provide members with access to quality health care services delivered in a cost-effective and compassionate manner, what it means to be a model public agency and community health plan, and the importance of building and maintaining an integrated and well-coordinated system of care.
An overview of the federal, state, and local landscape that sets the stage for the opportunities and challenges to CalOptima’s work and how it interacts with its daily operations and longer-term strategic vision.
A Close Look at Medi-Cal Managed Care: Stories of Quality Improvement Success
An examination of the experiences and best practices of subset of Medi-Cal Managed Care Plans that have been successful in raising quality scores over a nine-year period.
An examination of health plan and community-based organization (CBO) collaborations that are working together to address the needs of older adults who have a number of medical and functional needs. And an assessment of strategies, including regulatory and statutory changes, that could better support the integration of the medical and social models of care to address social determinants of health.
A primer on the Medi-Cal program that includes a profile of the population served by Medi-Cal, the application process, available benefits and services, carve-outs or exclusions, responsibility of the oversight entities, performance measurement, financing, pilot programs, and future policy considerations.
A fact sheet that breaks down the complicated federal, state, and local funding structure of the Medi-Cal program. Including how it is organized, what funding sources it uses, and the process for developing the Medi-Cal program budget.
Medi-Cal Payment to Managed Care Plans: Current Process and Challenges
A fact sheet that provides a broad overview of Medi-Cal managed care reimbursement. Including an overview of the contracting process, how payment rates are set, and how changes to the Medi-Cal program might impact payment rates. It also previews what is ahead for Medi-Cal managed care plans, including addressing costs and quality, and the move value-based payment for care models.
