Medi-Cal Managed Care Models and Enrollment in 4 1 5 · County Provider County County Medical Services Program Provider County Provider County Provider County Medi-Cal Enrollment1

InsuretheUninsuredProject10-10-2017

TotalPopulation1 39.4millionUninsuredPre-AffordableCareAct(ACA)–20132 17.9%UninsuredPost-ACA–20163 7.1%Medi-CalEnrollment1PercentofStateResidentsEnrolledinMedi-Cal

13.5million

34%Medi-CalManagedCareModelsandEnrollmentinCalifornia4

Two-PlanModel–7.0millionCountyOrganizedHealthSystems–2.2million

GeographicManagedCare–1.2millionRegionalModel–302,079

ImperialandSanBenitoModel–84,622Medi-CalAdultACAExpansion1 3.7million

Medi-CalAdultACAExpansionPercentofTotalPopulation1

9.5%

CoveredCaliforniaEnrollment5 1.3million

CoveredCaliforniaEnrollmentasaPercentofTotalPopulation

3.2%

HealthPlansinCoveredCaliforniaandEnrollment–20176

AnthemBlueCrossofCalifornia*–308,740BlueShieldofCalifornia–389,710

ChineseCommunityHealthPlan–11,820HealthNet–142,630

KaiserPermanente–297,320L.A.CareHealthPlan–10,400MolinaHealthcare–67,520OscarHealthPlan–1,810SharpHealthPlan–19,560UnitedHealthcare–1,080ValleyHealthPlan–3,360

WesternHealthAdvantage–7,180

*AnthemBlueCrossexitedmostregionsintheCoveredCAMarketin2018

Medi-Cal2020Waiver:WholePersonCareCounties/Projects

AlamedaCountyHealthCareServicesAgencyCityofSacramento

ContraCostaHealthServicesCountyofMarin,DeptofHealthandHumanServices

CountyofOrange,HealthCareAgencyCountyofSanDiego,Health&HumanServicesAgency

CountyofSantaCruz,HealthServicesAgencyCountyofSonoma,DeptofHealthServices

KernMedicalCenterKingsCountyHumanServicesAgency

LosAngelesCountyDeptofHealthServicesMendocinoCountyHealthandHumanServicesAgency

MontereyCountyHealthDeptNapaCounty


Medi-Cal2020Waiver:WholePersonCareCounties/ProjectsCont.

PlacerCounty,HealthandHumanServicesDeptRiversideUniversityHealthSystem–BehavioralHealthSanBernardinoCnty–ArrowheadRegionalMedCntr

SanFranciscoDeptofPublicHealthSanJoaquinCountyHealthCareServicesAgency

SanMateoCountyHealthSystemSantaClaraValleyHealthandHospitalSystemSmallCountyWholePersonCareCollaborative

ShastaCountyHealthandHumanServicesAgencySolanoCountyHealthandSocialServices

VenturaCountyHealthCareAgencyMedi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystem

SanMateo–2/1/17LiveDateRiverside–2/1/17LiveDateMarin–4/1/17LiveDate

SantaClara–6/15/17LiveDateContraCosta–6/30/17LiveDateSanFrancisco–7/1/17LiveDate

LiveDatePending:

SantaCruz,Napa,Monterey,Ventura,SanLuisObispo,Alameda,Sonoma,Kern,Orange,Yolo,Imperial,SanBernardino,SantaBarbara,SanBenito,Placer,Fresno,

SanDiego,Merced,Sacramento

LiveDatePending–PartnershipRegionalModel:Humboldt,Lassen,Mendocino,Modoc,Shasta,

Siskiyou,Solano,Trinity1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:StateandNationalEstimates,2013.Availableat:http://familiesusa.org/sites/default/files/documents/enroll-america/Enroll%20America%20State%20and%20National%20%20Uninsured%20Rate%20Estimates_%202013-2016.xlsx3RobinA.Cohen,EmilyP.Zammitti,andMichaelE.Martinez,“HealthInsuranceCoverage:EarlyReleaseofEstimatesFromtheNationalHealthInterviewSurvey,2016,”May2017,https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201705.pdf.4DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.July2017.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx5CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/6CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/

AlamedaContraCosta Marin

SanFrancisco SanMateo SantaClara

TotalCountyPopulation1

1,637,712 1,129,894 263,257 871,185 768,122 1,930,215

UninsuredPre-AffordableCareAct(ACA)—20132

14% 12% 9% 12% 11% 12%

UninsuredPost-ACA–20163

5% 4% 3% 5% 4% 4%

IndigentCareModel4 ProviderCounty

ProviderCounty

CountyMedicalServicesProgram

ProviderCounty

ProviderCounty

ProviderCounty

Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal

437,981

26.7%

277,046

24.5%

45,810

17.4%

224,947

25.8%

155,776

20.3%

446,988

23.2%

Medi-CalManagedCareModels5

TwoPlan TwoPlan CountyOrganized

HealthSystem(COHS)

TwoPlan COHS TwoPlan

Medi-CalManagedCareEnrollmentbyPlan6

AlamedaAllianceforHealth258,357

AnthemBlueCross62,924

ContraCostaHealthPlan183,195


PartnershipHealthPlanofCalifornia37,582

SanFranciscoHealthPlan135,377


HealthPlanofSanMateo113,309

SantaClaraFamilyHealth271,410


Medi-CalAdultACAExpansion1

129,161 74,730 14,993 79,793 49,740 138,903


7.9% 6.6% 5.7% 9.2% 6.5% 7.2%

CoveredCaliforniaEnrollment7

58,710 37,040 11,740 34,650 23,100 55,910


3.6% 3.3% 4.5% 4.0% 3.0% 3.0%


Alameda

ContraCosta Marin

SanFrancisco SanMateo SantaClara

CoveredCaliforniaHealthPlanEnrollment7*AnthemBlueCrossexitedthisCoveredCaliforniaMarketin2018

*AnthemBlueCross5,990

BlueShieldofCalifornia21,750

KaiserPermanente

30,970



HealthNet480

KaiserPermanente

20,920

*AnthemBlueCross2,300BlueShieldofCalifornia2,760

HealthNet200

KaiserPermanente

5,490

WesternHealth

Advantage1,000



ChineseCommunityHealthPlan(CCHP)9,510

HealthNet340

KaiserPermanente

11,420



CCHP2,310

HealthNet620

KaiserPermanente

12,410


BlueShield6,740

HealthNet990

KaiserPermanente

20,570

ValleyHealthPlan3,350


Estimated5-Year

BeneficiaryCount:20,000

Estimated5-Year


Estimated5-Year


Estimated5-Year


Estimated5-Year


Estimated5-Year


Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystemCounties

LiveDatePending

06/30/2017 04/01/2017 07/01/2017 02/01/2017 06/15/2017

1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/


SanBenitoSanLuisObispo

SantaBarbara SantaCruz Monterey Ventura


58,014 278,917 448,353 276,249 441,129 854,383


19% 15% 18% 15% 21% 15%

UninsuredPost-ACA—20163

6% 5% 8% 5% 9% 5%

IndigentCareModel4 CountyMedicalServicesProgram

Payer Hybrid Hybrid Provider Provider


19,031

32.8%

62,149

22.3%

146,897

32.8%

79,596

28.8%

183,225

41.5%

240,926

28.2%

Medi-CalManagedCareModel5

SanBenito CountyOrganized

HealthSystem(COHS)

COHS COHS COHS COHS



CenCal55,487

CenCal121,953

CentralCaliforniaAllianceforHealth69,505


GoldCoastHealthPlan207,186


4,802 18,723 34,806 23,565 38,301 67,250


8.3% 6.7% 7.8% 8.5% 8.7% 7.9%


1,490 12,150 15,600 12,800 12,800 33,060


2.6% 4.4% 3.5% 4.6% 2.9% 3.9%


SanBenitoSanLuisObispo

SantaBarbara SantaCruz Monterey Ventura

CoveredCaliforniaHealthPlanEnrollment7

*AnthemBlueCrossexitedtheCoveredCaliforniaMarketinthisregionin2018.

AnthemBlueCross*920

BlueShieldofCalifornia

530

UnitedHealthcare

40

AnthemBlueCross*4,310


UnitedHealthcare

90



UnitedHealthcare

50



HealthNet1,140

KaiserPermanente

10

UnitedHealthcare

130



910

UnitedHealthcare

160



KaiserPermanente

6,320

UnitedHealthcare

190


SanBenito,Mariposaand

Plumas

Estimated5-Year

BeneficiaryCount427

Estimated5-Year

BeneficiaryCount1,000

Estimated5-Year

BeneficiaryCount500

Estimated5-Year


Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystem

LiveDatePending

LiveDatePending

LiveDatePending

LiveDatePending

LiveDatePending

LiveDatePending

1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2017.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2017.Availableat:http://hbex.coveredca.com/data-research/


Fresno Kern Kings Madera Merced

SanJoaquin Stanislaus Tulare


989,183 888,994 149,407 155,693 272,610 738,873 545,008 468,235

UninsuredPre-AffordableCareAct(ACA)-20132

23% 22% 23% 22% 24% 20% 21% 24%


9% 9% 8% 10% 8% 7% 7% 10%

IndigentCareModel4

PayerCounty

ProviderCounty

CountyMedicalServicesProgram(CMSP)

CMSP PayerCounty

ProviderCounty

HybridCounty

HybridCounty

Medi-CalEnrollment1

PercentofCountyResidentsEnrolledinMedi-Cal

494,974

50%

411,389

46%

56,600

38%

70,038

45%

139,773

51%

300,739

41%

245,437

45%

258,523

55%


TwoPlan TwoPlan TwoPlan TwoPlan CountyOrganizedHealthSystem(COHS)

TwoPlan TwoPlan TwoPlan


CalVivaHealth297,551


KernFamilyHealth239,342

HealthNet78,873

CalVivaHealth25,760


CalVivaHealth35,214



HealthPlanofSanJoaquin217,331

HealthNet25,009

HealthPlanofSanJoaquin122,039

HealthNet75,185


HealthNet111,570


120,303 98,159 13,410 15,328 33,234 75,025 64,410 56,599


12.2% 11.0% 9.0% 9.8% 12.2% 10.2% 11.8% 12.1%


22,320 16,220 2,270 4,050 9,180 22,350 16,770 10,270


Fresno Kern Kings Madera Merced

SanJoaquin Stanislaus Tulare


2.25% 1.82% 1.52% 2.60% 3.37% 3.02% 3.08% 2.19%

CoveredCaliforniaHealthPlanEnrollment7*AnthemBlueCrossexitedthisCoveredCaliforniamarketin2018



9,450

HealthNet20

KaiserPermanente

5,950

UnitedHealthcare

240



8,370

HealthNet380

KaiserPermanente

2,590

*AnthemBlueCross

730


1,380

KaiserPermanente

140

UnitedHealthcare

20



1,820

KaiserPermanente

1,040

UnitedHealthcare

40



700

HealthNet30



1,760

HealthNet60

KaiserPermanente

8,890



1,500

HealthNet70

KaiserPermanente

5,510



560

HealthNet130

KaiserPermanente

70

Medi-Cal2020Waiver:WholePersonCarePilot

Notparticipating

Estimated5-Year


Estimated5-Year

BeneficiaryCount:790

Notparticipating

Notparticipating

Estimated5-Year


Notparticipating

Notparticipating


LiveDatePending

LiveDatePending

LiveDatePending

Notparticipating

LiveDatePending

LiveDatePending

LiveDatePending

LiveDatePending

1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/


Imperial SanBernardino RiversideTotalCountyPopulation1 187,157 2,147,933 2,360,727UninsuredPre-AffordableCareAct(ACA)—20132

28% 22% 20%

UninsuredPost-ACA—20163 12% 7% 7%IndigentCareModel4 CountyMedical

ServicesProgramProvider Provider


94,150

50.3%

882,666

41.1%

846,343

35.9%

Medi-CalManagedCareModels5 Imperial Two-Plan Two-PlanMedi-CalManagedCareEnrollmentbyPlan6

MolinaHealthcare15,972

CAHealth&Wellness58,847

InlandEmpireHealthPlan620,286


InlandEmpireHealthPlan603,240


Medi-CalAdultACAExpansion1 22,165 231,114 211,834


11.8% 10.8% 9%

CoveredCaliforniaEnrollment7 7,830 51,300 62,460CoveredCaliforniaEnrollmentasaPercentageofTotalPopulation

4.1% 2.4% 2.6%

CoveredCaliforniaHealthPlanEnrollment8*AnthemBlueCrossexitedthisCoveredCaliforniaMarketin2018


BlueShield1,110

KaiserPermanente30


UnitedHealthcare30


BlueShield16,460

HealthNet10,950

KaiserPermanente10,240



BlueShield20,920

HealthNet12,490




Estimated5-YearBeneficiaryCount2,000

Estimated5-YearBeneficiaryCount38,000

Medi-Cal2020Waiver:DrugMedi-Cal—OrganizedDeliverySystem

LiveDatePending LiveDatePending LiveDate:February1,2017


1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/

Insure the Uninsured Project 10-‐10-‐2017

Total Population1

10,229,245

Uninsured Pre-‐ Affordable Care Act (ACA)—20132

21%

Uninsured Pre-‐ Affordable Care Act (ACA)—20163

7%

Indigent Care Model4 Provider

Medi-‐Cal Enrollment1 Percent of County Residents Enrolled in Medi-‐Cal

3,980,427

39%

Medi-‐Cal Managed Care Model5 Two-‐Plan Model

Medi-‐Cal Managed Care Enrollment by Plan6 L.A. Care – 1,944,949 Health Net – 985,893

Medi-‐Cal Adult ACA Expansion1 1,160,738

Medi-‐Cal Adult ACA Expansion Percent of Total Population1 11.3% Covered California Enrollment7 335,050

Covered California Enrollment as a Percentage of Total Population

3.3%

Covered California Health Plan Enrollment7

*Anthem Blue Cross exited the Los Angeles Covered California Market in 2018

Anthem Blue Cross of California* 53,800

Blue Shield of California

118,110

Health Net 74,080

Kaiser Permanente

49,200

L.A. Care Health Plan 10,390

Molina Healthcare

27,870

Oscar Health Plan 1,600

Medi-‐Cal 2020 Waiver: Whole Person Care Counties / Projects

Estimated 5-‐year Beneficiary Count 154,044

Medi-‐Cal 2020 Waiver: Drug Medi-‐Cal – Organized Delivery System Counties

Live Date -‐ July 1, 2017

Insure the Uninsured Project 10-‐10-‐2017

1 California Department of Health Care Services. Medi-‐Cal’s Optional Adult ACA Expansion Population – October 2016. Released March, 2017. Available at http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf 2 Enroll America. Uninsured rates for Non-‐elderly Adults: All Counties in California, 2013. Available at: https://s3.amazonaws.com/assets.enrollamerica.org/wp-‐content/uploads/2015/11/CA-‐State-‐Snapshot-‐County-‐table.pdf 3 Enroll America. Uninsured rates for Non-‐elderly Adults: All Counties in California, 2016. Available at https://s3.amazonaws.com/assets.enrollamerica.org/wp-‐content/uploads/2016/11/18133102/CA_CountyData_2016.pdf 4 Provider counties offer health care services to eligible low-‐income persons through county-‐owned / operated hospitals and clinics consistent with each county’s indigent care program rules. Payer counties contract with and/or reimburse providers in the community pursuant to indigent care program rules developed by each county. Hybrid counties operate county clinics and contract with / reimburse private hospitals and providers. Thirty-‐six smaller counties contract with the County Medical Services Program to administer health care services for low-‐income individuals pursuant to CMSP program rules set by participating counties. 5Department of Health Care Services. Medi-‐Cal Managed Care Health Plan Directory. Available at http://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx 6Department of Health Care Services. Total Certified Medi-‐Cal eligibles; managed care enrollees by plan. October 2016. Available online at: http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx 7 Covered California. Active Subscribers as of September 2017. Available at: http://hbex.coveredca.com/data-‐research/


ElDorado Napa Placer Sacramento Solano Sonoma Yolo


184,180 142,269 376,092 1,506,677 434,102 503,953 216,866

UninsuredPre-AffordableCareAct(ACA)–20132

12% 14% 10% 17% 14% 14% 16%


4% 5% 3% 6% 4% 5% 5%

IndigentCareModel4

CountyMedicalServicesProgram(CMSP)

CMSP HybridCounty

Hybrid CMSP CMSP CMSP


38,569

20.9%

32,683

23.0%

63,730

16.9%

558,168

37.0%

124,882

28.8%

127,856

25.4%

59,487

27.4%


Regional

CountyOrganizedHealthSystem(COHS)

Regional GeographicManagedCare

(GMC)

COHS COHS COHS

Medi-CalManagedCareEnrollmentbyEnrollment6


CAHealthand

Wellness19,387

KaiserPermanente

1,615

PartnershipHealthPlan28,788


CAHealthand

Wellness9,919

KaiserPermanente

5,849

AnthemBlueCross

177,524

HealthNet121,420

KaiserPermanente

81,054

Molina60,426

PartnershipHealthPlan

ofCA112,898


ofCA111,488


ofCA53,138


12,909 8,724 18,230 143,307 34,475 36,508 16,892


7.0% 6.1% 4.8% 9.5% 7.9% 7.2% 7.8%


7,950 4,970 13,740 41,910 10,540 20,870 5,510


4.3%

3.5% 3.7% 2.8% 2.4% 4.1% 2.5%


ElDorado Napa Placer Sacramento Solano Sonoma Yolo

CoveredCaliforniaHealthPlanEnrollment8*AnthemBlueCrossexitedtheCoveredCaliforniaMarketinthisregionin2018.


BlueShield2,090

HealthNet20

KaiserPermanente

2,110

WesternHealth

Advantage220

AnthemBlueCross*950

BlueShield1,010

HealthNet40

KaiserPermanente

2,440

WesternHealth

Advantage540


BlueShield4,020

HealthNet10

KaiserPermanente

5,730

WesternHealth

Advantage370


BlueShield6,690

HealthNet140

KaiserPermanente

23,940

WesternHealth

Advantage1,330


BlueShield1,010

HealthNet90

KaiserPermanente

7,190

WesternHealth

Advantage890


BlueShield4,750

HealthNet120

KaiserPermanente

10,190

WesternHealth

Advantage2,500


BlueShield1,270

HealthNet20

KaiserPermanente

2,100

WesternHealth

Advantage320


Estimated5-Year

BeneficiaryCount800

Estimated5-Year

BeneficiaryCount450

Estimated5-Year


Estimated5-Year

BeneficiaryCount250

Estimated5-Year



LiveDatePending

LiveDatePending

LiveDatePending

LiveDatePending

LiveDatePending

PartnershipRegionalModel

LiveDatePending

LiveDatePending

1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableatwww.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/


Butte Colusa DelNorte Glenn Humboldt LakeTotalCountyPopulation1

225,125 22,408 27,040 29,073 136,086 65,128


21% 22% 21% 22% 22% 22%


7% 11% 10% 10% 7% 9%

IndigentCareModel4 CountyMedicalServicesProgram(CMSP)

CMSP CMSP CMSP CMSP CMSP


82,672

36.7%

9,136

40.8%

11,970

44.3%

12,300

42.3%

54,899

40.3%

31,865

48.9%


RegionalModel

RegionalModel

COHS RegionalModel

COHS COHS






PartnershipHealthPlanof

CA11,195




CA51,693


CA29,554


24,813 1,805 3,079 2,774 19,000 8,992


11% 8.1% 11.4% 9.5% 14% 13.8%


6,780 890 600 890 5,740 1,970


3.0% 4.0% 2.2% 3.1% 4.2% 3.0%




AnthemBlueCross760


130

AnthemBlueCross530


80

AnthemBlueCross820


70



690



420


Butte Colusa DelNorte Glenn Humboldt LakeUnitedHealth

Care20

UnitedHealthCare10


NotParticipating

NotParticipating

NotParticipating

NotParticipating

NotParticipating

NotParticipating


NotParticipating

NotParticipating

NotParticipating

NotParticipating

LiveDatePending


NotParticipating



Lassen Mendocino Modoc Nevada Plumas ShastaTotalCountyPopulation1

30,645 88,995 N/A 98,552 19,494 178,208


15% 21% 19% 15% 18% 19%


6% 9% 9% 4% 6% 7%

IndigentCareModel4 CMSP CMSP CMSP CMSP CMSP CMSP


7,835

25.6%

40,670

45.7%

N/A

N/A

25,478

25.9%

6,223

31.9%

64,607

36.3%


COHS COHS COHS RegionalModel

RegionalModel

COHS



CA7,214


CA36,538


CA3,011






CA

60,244


2,031 12,441 N/A 8,480 2,046 17,305


6.6% 14% N/A 8.6% 10.5% 9.7%


460 4,050 220 6,390 840 6,930


1.5% 4.6% N/A 6.5% 4.3% 3.9%


Lassen Mendocino Modoc Nevada Plumas ShastaCoveredCaliforniaHealthPlanEnrollment7

AnthemBlueCross410


40



800

UnitedHealthCare20

AnthemBlueCross190


30



HealthNet10

UnitedHealthCare10

AnthemBlueCross720

BlueShield120


BlueShield800


NotParticipating

Estimated5-Year

BeneficiaryCount600

NotParticipating

NotParticipating

Estimated5-Year

BeneficiaryCount427

CollaborativewithMariposaandSanBenito

Counties

Estimated5-Year

BeneficiaryCount600


LifeDatePending


LifeDatePending


LifeDatePending


LiveDatePending

NotParticipating

LifeDatePending


1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Cal4ligible;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/


Sierra Siskiyou Sutter Tehama Trinity YubaTotalCountyPopulation1

N/A 44,372 98,191 64,098 13,482 76,129


17% 20% 20% 22% 21% 22%


6% 8% 8% 8% 6% 7%

IndigentCareModel4 CMSP CMSP CMSP CMSP CMSP CMSP


N/A

N/A

18,740

42.2%

42,461

43.2%

27,237

42.5%

5,028

37.3%

32,462

42.6%

Medi-CalManagedCareModels

RegionalModel

COHS RegionalModel

RegionalModel

COHS RegionalModel


AnthemBlueCross350

CAHealth&Wellness

214


CA17,493






CA4,585




N/A 5,277 10,503 6,304 1,732 7,745


N/A 11.9% 10.7% 9.8% 12.8% 10.2%


110 1,460 3,610 1,900 560 1,590


N/A 3.3% 3.7% 3.0% 4.2% 2.1%


AnthemBlueCross90


20



180



KaiserPermanente

50



220

AnthemBlueCross490


70



330

KaiserPermanente

140


Sierra Siskiyou Sutter Tehama Trinity YubaMedi-Cal2020Waiver:WholePersonCareCounties/Projects

NotParticipating

NotParticipating

NotParticipating

NotParticipating

NotParticipating

NotParticipating


NotParticipating

LifeDatePending


NotParticipating

NotParticipating

LifeDatePending


NotParticipating



TotalCountyPopulation1 3,181,371UninsuredPre-AffordableCareAct(ACA)—20132 15%UninsuredPost-ACA—20163 5%IndigentCareModel4 PayerCountyMedi-CalEnrollment6

PercentofCountyResidentsEnrolledinMedi-Cal

910,429

28.6%Medi-CalManagedCareModel5 CountyOrganizedHealthSystem(COHS)Medi-CalManagedCareEnrollmentbyPlan6 CalOptima

772,502Medi-CalAdultACAExpansion1 262,837Medi-CalAdultACAExpansionPercentofTotalPopulation1 8.3%CoveredCaliforniaEnrollment7 124,740CoveredCaliforniaEnrollmentasaPercentofTotalPopulation 3.9%CoveredCaliforniaHealthPlanEnrollment8

*AnthemBlueCrossexitedtheOrangeCountyCoveredCaliforniaMarketin2018



HealthNet22,500


OscarHealthPlan210

Medi-Cal2020Waiver:WholePersonCareCounties/Projects Estimated5-YearBeneficiaryCount9,303


LiveDatePending



TotalCountyPopulation1 3,300,891UninsuredPre-AffordableCareAct(ACA)-in20132 17%UninsuredPost-ACAin20163 5%IndigentCareModel4 PayerMedi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal

907,970

27.5%Medi-CalManagedCareModel5 GeographicManagedCareMedi-CalManagedCareEnrollmentbyPlan6 Care1stHealthPlan

82,187

CommunityHealthGroup284,335

HealthNet75,654



Medi-CalAdultACAExpansion1 267,055Medi-CalAdultACAExpansionPopulationasaPercentofTotalPopulation1

8.1%

CoveredCaliforniaEnrollment7 108,510CoveredCaliforniaEnrollmentasaPercentofTotalPopulation 3.3%CoveredCaliforniaHealthPlanEnrollment8

*AnthemBlueCrossexitedtheSanDiegoCoveredCAMarketin2018

AnthemBlueCrossofCalifornia9,240*


HealthNet17,660



SharpHealthPlan19,560

Medi-Cal2020Waiver:WholePersonCarePilot Estimated5-YearBeneficiaryCount

1,049


LiveDatePending

