Two-Plan model of Medi-Cal Managed Care in Imperial County

By Mario Conde

The County Board of Supervisors will move forward to create a Local Initiative as part of a Two-Plan model of Medi-Cal Managed Care in Imperial County.

At Tuesday’s meeting Robin Hodgking Director of County Public Health reported that they have remained engaged in planning for the mandated transition of Imperial County form the traditional Medi-Cal free-for-service model to a managed care model of healthcare financing and service delivery. Hodgking said they have worked with Pacific Health Consulting Group to identify a Medi-Cal Managed Care model that would be the most effective and successful in transitioning our unique and challenged health care safety net. The Health Leadership Forum strongly recommends the implementation of what is called a Two-Plan model.

In California there are three models of Medi-Cal Managed Care that have been approved by the California Department of Health Care Services but the County is opting for the Two-Plan Model. The Two-Plan model contains a county-developed public plan called a Local Initiative and a single commercial plan. Both the Local Initiative and the commercial plan contract with the California Department of Health Care Services to operate as health plans within the county. Since the existence of two plans offers a choice to Medi-Cal beneficiaries, it meets federal standards and does not require a federal waiver for implementation. Currently, there are 14 counties who have either individually implemented a Two-Plan model or, through a JPA, created a regional Two-Plan model.

“Since we began researching and planning for this transition back in August of 2012, local control has been recurring priority. We have also needed to balance unique needs of our community with the aggressive timeline called for in the California Budget Act mandate. The Two-Plan model meets both our need for local control and the implementation efficiency needed to meet the mandated implementation goals.” Hodgkin said.

Hodgkin added that the Local Initiative component of the Two-Plan model emphasizes local control, local accountability and connection to the community and will give the community the opportunity to participate in the governance of Medi-Cal managed care plan. Local initiative have also proven to have a lower administrative cost than commercial plans which helps to ensure that our local health care dollars are directed toward health care, health improvements and provider reimbursement, she said.

Supervisor Jack Terrazas thanked Hodgkin since this plan will benefit local population since will have local control and will position the County in a better position now with the health care reform that is coming soon.

Supervisor Ryan Kelley also agreed that this model will benefit the residents of the Imperial Valley and have the local health care providers be in control and better serve the community as opposed of having the State coming to the valley and directing everything from Sacramento. The board passed this item unanimously.  The Board also approved an MOU with Pacific Health Consulting Group in the amount of $43,495 in which Pioneers Memorial Health Care District, Clinicas de Salud, El Centro Regional Medical Center, and the Public Health Department will share equally the cost of the consultant.