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. All in all, 2019 has been a remarkable year.
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?
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.
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.
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
should be.
