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MEDI-CAL MANAGED CARE PROGRAM FACT SHEET

  • Listed: December 15, 2018 3:22 am
  • Expires: 998982 days, 13 hours

Description

MEDI-CAL MANAGED CARE PROGRAM FACT SHEET

 

Overview
Medi-Cal Managed Care is an organized
system to help you get high quality care and
stay healthy. Medi- Cal managed care health
plans help Medi-Cal beneficiaries find
doctors, pharmacies and health education
programs.

Managed care health plans also offer
• CareCoordination
• Ongoing referrals tospecialists
• 24-hour Nurse Advice telephone
services
• Customer service centers

Managed care serves about 10.8M Medi-Cal
beneficiaries in 58 counties. This is about
81% of the total Medi-Cal population.

In California, there are six models of managed
care.

County Organized Health Systems
County Organized Health Systems (COHS)
serve about 2.2M beneficiaries through six
health plans in 22 counties: Del Norte,
Humboldt, Lake, Lassen, Marin, Mendocino,
Merced, Modoc, Monterey, Napa, Orange,
San Luis Obispo, San Mateo, Santa Barbara,
Santa Cruz, Shasta, Siskiyou, Solano,
Sonoma, Trinity, Ventura and Yolo.

How It Works

In the COHS Model counties, the Department
of Health Care Services (DHCS) contracts
with a health plan created by the County
Board of Supervisors.

Local government, health care providers,
community groups, and Medi-Cal
beneficiaries are able to give input as the plan
is created. The health plan is run by the
county.

In a COHS county, everyone is in the same
managed care plan.

Geographic Managed Care (GMC)
GMC serves about 1.2M beneficiaries in two
counties: Sacramento and San Diego.

How It Works
In GMC counties, DHCS contracts with several
commercial plans. This provides more choices
for the beneficiaries.

Two-Plan
Two-Plan serves about 6.9M beneficiaries in
14 counties: Alameda, Contra Costa, Fresno,
Kern, Kings, Los Angeles, Madera, Riverside,
San Bernardino, San Francisco, San Joaquin,
Santa Clara, Stanislaus and Tulare.

How It Works
In Two-Plan Model counties, there is a Local
Initiative (county organized) and a
Commercial Plan. DHCS contracts with both
plans.

Regional
Regional serves about 300K beneficiaries in
18 counties: Alpine, Amador, Butte,
Calaveras, Colusa, El Dorado, Glenn, Inyo,
Mariposa, Mono, Nevada, Placer, Plumas,
Sierra, Sutter, Tehama, Tuolumne and
Yuba.
How It Works
In Regional Model counties, there are two
Commercial Plans that contract with DHCS.

Imperial
Imperial serves about 77K beneficiaries in
Imperial County.
How It Works
In the Imperial Model county, there are two
Commercial Plans that contract with DHCS.

San Benito
San Benito serves about 8K beneficiaries in San Benito County.
How It Works
In the San Benito Model county, there is
one Commercial Plan that contracts with
DHCS.

Beneficiaries can choose the managed care
plan or regular (fee-for-service)
Medi-Cal

 

Disclaimer: The community resource directory information is deemed accurate and up-to-date, however, you should always contact the agency or provider to confirm this information and make an appointment. Be sure to confirm payment information with the provider, if payment is required. We are not affiliated to any of the organizations listed in this app/website. The information provided in this app/site is for the benefit of the community and and we are not liable for any information changed from the date we published this information. Please contact us if you like to make any changes in the information by emailing beracahsites@gmail.com

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