What is Medi-Cal Managed Care?
Medi-Cal is health insurance for low-income individuals and families who meet certain requirements. In the past, Medi-Cal provided beneficiaries with a fee-for-service care delivery system, in which state and federal funding paid health care providers separately for each service the patient received. With managed care, the state contracts with health maintenance organization (HMO) plans for a set rate to administer health care services.
Medi-Cal Managed Care started as a pilot program in urban and suburban areas of California. Results of the pilot were positive and on November 1, 2013, the program was expanded to the remaining 28 rural counties in the state, including Tuolumne and Calaveras counties.
Under this new system, Medi-Cal beneficiaries are now required to choose a health plan. In Tuolumne and Calaveras counties, the managed care plans available are Anthem Blue Cross and California Health and Wellness. Both health plans provide a group of health care providers including clinics, specialists and pharmacies. Beneficiaries are required to choose one primary care provider who will coordinate referrals and other medical services within the health plan for the patient.