Local Medi-Cal Health Plans Call on the Administration and Legislature to Adopt Alternative Proposal Protecting Care for Nearly 2 Million Californians
Medi-Cal Fee-For-Service Shift Would Leave Coverage in Name Only, Coalition Warns

SACRAMENTO – With the state budget process entering its final stretch, the Local Health Plans of California (LHPC) and a broad coalition of state and local safety net providers, health plans, local government, and advocates are calling on the Administration and Legislature to adopt the coalition’s alternative proposal that maintains access and coordination through Medi-Cal managed care rather than transitioning undocumented Medi-Cal enrollees into a fragmented fee-for-service (FFS) system.

“We urge the Legislature, especially members who have championed the expansion of Medi-Cal to all low-income Californians regardless of immigration status, to stand up for the nearly 2 million Californians whose health care hangs in the balance,” said LHPC CEO Linnea Koopmans. “This window is closing fast, and unless action is taken, cancer patients could lose their doctors mid-treatment, families could lose their children’s pediatrician, and people currently receiving behavioral health care could lose their therapist.”

Under the alternative proposal, undocumented Medi-Cal enrollees would remain connected to their existing health plan, provider network, care coordination, and member services. Rather than shifting this population into FFS, as proposed by the Administration, this approach avoids disrupting care for Medi-Cal members, while still complying with new federal rules and achieving budget savings. By contrast, FFS would strip away the structure that makes coverage meaningful. There is no care coordination, no network adequacy standards, and no accountability for access to care. Rather than being transferred to a new provider, they would be left to search for doctors on their own. For many, that search will come up empty.

“The Administration’s proposal scores savings by assuming drastic reductions in outpatient and preventive services, which is proof that fee-for-service results in lost health care,” Koopmans continued. “The Legislature and the Administration can protect access to care for this vulnerable population with our proposal. We’re asking them to do the right thing.”

These enrollees have existing relationships with providers that FFS would put at risk:

• 34,000 cancer patients mid-treatment who would need to find an oncologist willing to accept FFS rates, with no transition plan to make sure one exists
• 70,000 people receiving behavioral health treatment, where continuity with a single provider is often central to the treatment itself
• 689,000 patients receiving specialty care for chronic conditions who may need to start over with a new provider mid-course of treatment

“We are grateful to the Legislators who have stood with this coalition and pushed for a better path,” Koopmans said. “Their advocacy has made clear that there is a better way to comply with federal requirements without abandoning vulnerable Californians to a system that cannot serve them.”

Along with LHPC, statewide coalition members include the Latino Caucus of California Counties, California Primary Care Association, California Association of Public Hospitals and Health Systems, Private Essential Access Community Hospitals, California Medical Association, California Association of Health Plans, California Alliance, District Hospital Leadership Forum, Children Now, County Behavioral Health Directors Association of California, Latinx Physicians of California, Medi-Cal CBO Coalition, America’s Physician Groups, First 5 Association of California, California Academy of Family Physicians, and Steinberg Institute.

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MORE:

• Robust Access & Member Protections Lost Under Medi-Cal Fee-for-Service
• Medi-Cal UIS Members Face Major Access and Continuity Risks Under a Fee-for-Service Transition
• UIS Impact Data
• Coalition letter

About LHPC

Local Health Plans of California (LHPC) is a statewide trade association that represents all 17 of the community-based, not-for-profit health plans that provide access to critical and comprehensive healthcare services for low-income populations enrolled in California’s Medicaid program, “Medi-Cal,” in 51 out of 58 counties in the state. With 9.1 million enrollees, our plans serve approximately 70 percent of all Medi-Cal managed care beneficiaries. More here.

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