Welcome to the first issue of LHPC Works, a publication dedicated to providing information and insights about the issues confronting California’s local health plans and the priorities they are working on to provide high quality, accessible health care coverage for millions of Californians enrolled in Medi-Cal (California’s Medicaid program). The local plans’ story began nearly 50 years ago with one county’s vision of creating a health plan directly connected and accountable to its community.
The conditions in which people are born, grow, live, work, and age have such significant influence on an individual’s health that the World Health Organization calls them “social determinants of health” (SDOH). Local plans, with a depth of understanding about and connections to their communities, are finding creative solutions to better bridge the divide between health care delivery and SDOHs – with particular focus on housing, which is among the most pressing and complex of SDOHs to address within regulatory restrictions.
California’s successful implementation of the ACA gave millions of people access to health insurance. The rapid expansion of the Medi-Cal program – over 4 million since 2013 – meant health plans had to focus on creative solutions to account for longstanding provider shortages and meet regulatory and contractual access requirements. Access challenges exist across California, but are felt most acutely in rural areas, where obstacles faced by both health care providers and patients are vastly different from those in urban areas.
The Medi-Cal managed care program currently covers approximately
10.6 million Californians, an increase of more than four million
since 2013. This dramatic growth in a relatively short period of
time – combined with provider shortages, diverse member
demographics and vast geographic and market variations across
California – makes quality improvement a complicated and
significant undertaking. Nevertheless, care quality is a top
priority for policy makers, health plans, and consumers. As it