Program Resources: Medi-Cal Managed Care Finance 101
April 8, 2020
The California Endowment
Sacramento
Welcome to the Medi-Cal Managed Care Finance 101 program resources web page. Below are information and materials you may find helpful when preparing for and attending the event.
Overview
How is the Medi-Cal program funded?
How does DHCS determine the rates it pays to managed care plans?
How does the state oversee plan finances?
Medi-Cal managed care financing is nothing short of complex. Join us for this introductory course and get answers to these questions and more. Expert faculty will discuss:
- How funds flow from the federal and state governments to the plans
- Rate development process
- Regulatory oversight of plan finances
- Special issues in Medi-Cal financing — carve-outs, safety net and other issues
- Emerging issues and challenges in Medicaid financing
Who should attend:
Local health plan staff interested in learning the basics of Medi-Cal managed care financing. The course may be most valuable and informative for non-finance staff and staff who are new to managed care finance.
Course Schedule
*May be subject to change
9:30 – 9:55 a.m. | Welcome & Introductions
9:55 – 10:15 a.m. | Overview: Health Coverage Financing Fundamentals
Pete Nakahata
Participants will receive a macro-level overview of the national market for purchasing coverage and the importance of Medicaid’s place within it.
10:15 – 11:00 a.m. | Key Concepts in Federal & State Financing of Medi-Cal Managed Care
Jonathan Freedman
The session will look closer at federal Medicaid financing concepts such as FMAP, enhanced match and how the State funds the non-federal share. Faculty will also describe the related State budget process, how local plans are funded and otherwise impacted by it, and other key issues and concepts relating to how Medi-Cal is funded.
11:00 – 11:15 a.m. | Break
11:15 a.m. – 12:30 p.m. | How California Pays Medi-Cal Plans: The Rate Development Process
Meredith Wurden
This session will delve deeper into key components of the State’s Medi-Cal Managed Care rate development process, covering federal and state rate requirements, actuarial soundness, the role of data, differences between Medicaid and CHIP funding, and best practices for ensuring fair payment. Participants will also gain an understanding of concepts such as kick payments, risk adjustment, recoupment and efficiency factors.
12:30 – 1:20 p.m. | Hosted Lunch
1:20 – 1:40 p.m. | Networking Exercise
1:40 – 2:20 p.m. | How State Regulators Oversee Plan Finances
Gil Riojas
Participants will gain an understanding of the role of the Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) in financial oversight of Medi-Cal Managed Care plans. This will include learning about plan filings and key concepts, such as tangible net equity and medical loss ratios.
2:20 – 2:35 p.m. | Break
2:35 – 2:55 p.m. | Special Issues in Funding Medi-Cal
Jonathan Freedman
Participants will learn about the important role and current issues pertaining to the financing of carved out benefits, safety net financing and other special payment concepts that help fund Medi-Cal. Participants will also learn about issues that may impact financing of Medi-Cal services in the future.
2:55 – 3:45 p.m. | Ask the Experts
Meredith Wurden, Gil Riojas, Jonathan Freedman
This panel discussion will engage participants in an interactive discussion on key emerging issues and challenges in Medicaid financing. Participants will be able to ask the experts about various Medi-Cal financing issues and other burning questions.
3:45 – 4:00 p.m. | Wrap-Up & Closing
Materials
Pre-meeting materials:
CHCF’s Modernizing Medi-Cal Rate Setting to Improve Health and Manage Costs
Presentation materials:
Please refer to your registrant reminder email for the password to access the materials.
Reference materials:
Glossary of Health Care Terms and Acronyms
Faculty
Gil Riojas
Chief Financial Officer
Alameda Alliance for Health
Gil Riojas is Chief Financial Officer at Alameda Alliance for Health (Alliance) with responsibility for the overall financial management of the organization. This includes oversight of financial budgeting and forecasting, accounting, financial reporting and other related activities. Prior to joining the Alliance, Gil worked for more than 15 years at the California Department of Managed Health Care where he oversaw the Financial Review Office and was responsible for monitoring the financial solvency and compliance of more than 124 managed care plans in California.
Meredith Wurden
Former Director, Policy and Fiscal Strategy for Partnership HealthPlan of California
Meredith Wurden most recently served as the Director of Policy and Fiscal Strategy at Partnership HealthPlan of California (PHC) where she was responsible for fiscal policy development and communication. Prior to joining PHC, Meredith worked for the state of California for nearly ten years. She also previously served as Assistant Deputy Director of Health Care Financing at the California Department of Health Care Services and with the California State Legislature covering health issues, including as a principal fiscal and policy analyst for the non-partisan California Legislative Analyst’s Office and as Deputy Director at the California Senate Office of Research. Meredith also worked at the federal Government Accountability Office.
Jonathan Freedman
Vice President
Health Management Associates
Jonathan Freedman works with plans, providers, associations, and governmental and non-governmental entities in the areas of public health, safety net health care, and public policy. His work focuses on strategic planning, public health improvement and transformation, and the health care safety net. Prior to joining HMA, Mr. Freedman held a variety of management and leadership roles at L.A. Care Health Plan and with the County of Los Angeles, and led a number of high-profile health- and health care-related initiatives.
Pete Nakahata
LHPC Institute Advisor
Pete Nakahata is an LHPC Institute Advisor and assists in the development and implementation of the Institute’s training courses and educational programs. Pete is also Principal and Founder of PTN Consulting Group, LLC, a California-based consulting firm that provides professional consulting services to clients on health insurance exchange and Medicaid managed care related issues. Before returning to consulting, he was a Senior Advisor at CMS’ Center for Consumer Information and Insurance Oversight (CCIIO) and played a critical role in the establishment and operation of both the federally facilitated and State-based exchanges. Pete was also Executive Officer for Strategic Development at CalOptima and part of its original startup team. He has more than 25 years of experience in government-sponsored and private health coverage, including individual market health insurance, Medicaid managed care, Medicare Advantage and community-based nonprofit health programs.
Site/Parking
The California Endowment
1414 K Street
Sacramento, CA 95814
Room: Adelante Room (Suite 100)
Entry/Parking Instructions:
Download driving and parking instructions
Feedback Survey
Thank you for attending!
At the conclusion of the program, we are kindly requesting your feedback on the course via a brief online survey, which should take only a few minutes to complete. We truly value your thoughts and opinions, and we will use the feedback we receive to shape and develop future programs.
For questions or comments, please contact the LHPC Institute at institute@lhpc.org.