Medi-Cal: managed care.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. Existing law allows the department to contract with one or more prepaid health plans in order to provide Medi-Cal benefits. Existing law allows the Director of Health Care Services to contract with any qualified individual, organization, or entity, including counties, to provide services to, or arrange for or case manage the care of, Medi-Cal beneficiaries. This bill would establish the Medi-Cal Managed Care Pilot Program. Under this program, until July 31, 2016, and subject to the receipt of any necessary federal waivers, the department would be required to provide all seniors and persons with disabilities in the Counties of Riverside and San Bernardino who are not expressly excluded from enrollment with the ability to enroll in a Medi-Cal managed care health plan. The bill would require the department, by July 1, 2010, to complete an implementation plan containing specified elements and prepared in consultation with a health care stakeholder advisory committee, which this bill would require the department to convene in accordance with specified criteria, and to take certain other actions relating to the development of the pilot program. The bill would impose various requirements on managed care plans participating in the program. The bill would require the department to seek federal approval for the program, and to conduct, and, by March 1, 2014, report to the Legislature the results of, an evaluation of the program.