Managed Care Plan County Model Change Information
County Model Change for the 2024 Medi-Cal Managed Care Plan Procurement
In 2021, DHCS began a statewide procurement process of commercial Medi-Cal managed care plans (MCPs) for the new MCP contract effective January 1, 2024. Counties have the opportunity to change the managed care plan model that operates in their county.
If a county transitions to a model that includes a local plan, DHCS may remove that county from the commercial plan procurement (for a single local plan model) or reduce the number of commercial plans procured in the county (for a Two-Plan Model). Counties interested in shifting to a local plan model through an arrangement with an existing managed care plan or the formation of a new local plan independent of an existing managed care plan, were asked through the
County Managed Care Transition to Local Plan: Letter of Intent Instructions to submit their Letter of Intent by April 30, 2021.
As described in the Letter of Intent Instructions, DHCS has authority to determine which, and how many, managed care plans (MCPs) with which the State contracts for Medi-Cal services in counties. DHCS determination is ultimately guided by the best interests of Medi-Cal beneficiaries and State goals for the Medi-Cal managed care delivery system under CalAIM, namely to drive quality of care improvements, streamline and reduce complexity, and build on whole person care approaches.
DHCS evaluation entails assessment of historical quality of care performance and the financial health and viability of the entity. Applicants that DHCS conditionally approves move on to the next stage of the assessment process as outlined in the Model Change Timeline. Final decisions will be based on MCP operational readiness and CMS approval.
Listed below are resources with key information about the model change process:
As additional resources are made available, this page will be updated.
