Publication LHPC WorksOctober 2019 Issue

Message from the CEO

LHPCWorks was launched as an extension of our member health plans’ commitment to being accountable partners and leaders among California’s Medi-Cal stakeholder community. With the flurry of activity both federally and in California, LHPC has been hard at work advocating for policies and legislation that would enhance access and quality of care for Medi-Cal beneficiaries. As reported in the Legislative Wrap-Up, local plans closed out a busy legislative session with several important bills awaiting the Governor’s signature. We engaged DHCS leadership on a number of significant policy issues, including the MCO tax and impending pharmacy carve-out. We said goodbye to two outstanding health plan leaders and extended a warm welcome to those appointed to continue their important work. All in all, 2019 has been a remarkable year. Let’s take a moment to review a few noteworthy developments.

From day one, Governor Newsom put health care at the top of his agenda and renewed his commitment to expanding access to health care for the most vulnerable Californians. This was best exemplified by the administration’s Medi-Cal expansion to young adults under age 26 regardless of status.

We worked tirelessly with our members, stakeholders, the Administration and the Legislature to address the most significant organizational change to Medi-Cal in recent years — the Governor’s plan to move the health plan pharmacy benefit to fee-for-service. Over the course of the year, our members’ support grew for a statewide formulary and DHCS fiscal management of the benefit. However, we will continue to work closely with the Administration to ensure the transition to fee-for-service supports best practices in care and does not erode patient rights, outcomes, and access. With many competing points of view, LHPC has consistently been more than willing to work collaboratively on policy that could ultimately benefit all Medi-Cal managed care beneficiaries.

In the first year of a two-year session, the Legislature tackled some tough and complex issues impacting Medi-Cal enrollees. Topping the list, the Administration advanced and the Legislature passed a revised MCO tax formula that offers the best opportunity to secure federal approval and protect billions of dollars for Medi-Cal. LHPC was at the forefront of this issue, engaging a team that helped us analyze the financials and ultimately advocating for the passage of the new tax, which will preserve hospital care, doctors’ visits and mental health treatment for our health care safety net.

Recently, local health plans’ impact on the communities they serve received some well-deserved recognition. Over the course of the year, our not-for-profit health plans’ successful models have been held up as examples of what the future of health care can look like. The Atlantic highlighted how L.A. Care, the nation’s largest Medicaid health plan, is successfully operating as a public option, competing directly with commercial insurers, and offering quality, localized care for millions. Additionally, State Auditor Elaine Howle recognized the strength and efficacy of County Organized Health Systems in an August 2019 report. The state auditor praised Partnership HealthPlan’s locally designed program and their accessibility to doctors in rural regions as compared to other plans.

We expect to have a full plate as we look to 2020. The submission of the state’s new Medicaid waiver to the federal government will consume considerable time and energy for local plans, the state and all of those involved. At the same time, a number of Medi-Cal plans will go through the Department of Health Care Services’ competitive procurement process. Rates will be another top priority as we head into the next year. This is all in addition to the usual heft of health care bills that work their way through the Legislature and day-to-day state oversight of Medi-Cal managed care plans.

Before we jump into the future, we want to also take a moment to thank some real champions who have moved on to new challenges and opportunities. The LHPC Board saw two fierce advocates for good health policy, a robust Medi-Cal system and thriving local plans head into retirement. The impact of IEHP’s Brad Gilbert and Contra Costa Health Plan’s Patricia Tanquary’s leadership will remain for years to come. We know they are still in our orbit, but we want to thank them for their decades of commitment and dedication to LHPC and the Medi-Cal program.

We also want to acknowledge Jennifer Kent’s years at the helm of the Department of Health Care Services. In her many state jobs over the years, culminating with her time as Director, Jennifer has been a tireless public servant committed to putting her best effort into serving the people of California. Leading a large, complex department like DHCS is a monumentally difficult task and we thank her for her willingness to serve.

Local health plans have a lot to be proud of. As 2020 approaches and a new legislative session begins, we will continue in our commitment to work on priority issues in close partnership with our Medi-Cal community.


Brianna Lierman, Esq.
Chief Executive Officer
Local Health Plans of California

Publication LHPC WorksOctober 2019 Issue

“Carving Out” Medi-Cal’s Pharmacy Benefit: What California Can Learn from 13 Other States

The proposed Medi-Cal pharmacy carve-out —“Medi-Cal Rx” — will transfer the pharmacy benefit offered by health plans back to the fee-for-service program, where it would be administered by a pharmacy benefit manager. The carve-out concept is not untested. Are there lessons learned for California to do it differently? 

Publication LHPC WorksOctober 2019 Issue

Legislative Wrap-Up

Taxes. Sanctions. Oversight. Data sharing. We covered it all in the first half of the 2019-20 legislative session.

Publication LHPC WorksOctober 2019 Issue

Federal Regulatory Actions Threaten the Health of Low-Income Californians

Federal regulatory activity over the past year has continued to target immigrants and low-income households. These proposed or final policies — including public charge, changing the poverty measure inflation factor, and requiring immigration status verification for households receiving housing assistance — fundamentally erode and disincentivize receipt of public services that are critical for the health and well-being of the nation’s most vulnerable populations.

Publication LHPC WorksOctober 2019 Issue

Spotlight On …
Jarrod McNaughton

Jarrod McNaughton, CEO of Inland Empire Health Plan, brings a person-focused philosophy to leadership and life. Learn more about his personal and professional goals, leadership approach and what makes him tick.