California Orders Health Net to Extend Assisted Living Benefits Through December After Termination Violations
California's Department of Health Care Services issued a corrective action plan requiring Health Net to extend assisted living and home care services for approximately 3,500 Medi-Cal members through December 31, 2026, after finding eight deficiencies in how the insurer handled benefit terminations. The state cited failures to submit transition plans, move members to appropriate care, and improper service denials that endangered vulnerable members. Health Net faces potential fines of $25,000 per member per day for non-compliance. The insurer, which operates Medi-Cal plans in 10 counties, still plans to end the optional CalAIM benefit in January 2027, leaving members at risk of nursing home placement or homelessness.
This enforcement action demonstrates state authority to require benefit continuity for optional Medicaid services when MCOs fail care transition obligations, but leaves unresolved whether continuity-of-care protections apply when members switch plans offering the same benefit.
LTSS · Managed Care
You might also like