Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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California Health Care Foundation

18 stories

Industry·CA·4d ago

Former MemorialCare CEO Argues Fee-for-Service Undermines Care Value

In a California Health Care Foundation commentary, the former longtime CEO of MemorialCare argues that fee-for-service payment rewards volume over prevention and drives unsustainable cost growth in California's health system. The author, who sits on the advisory committee of the state's Office of Health Care Affordability, cites MemorialCare's own experience with alternative payment models (APMs), noting that shared-risk, population-based payment arrangements produced roughly 5% lower total spending and up to 25% lower pharmacy costs. The piece points to the state's four-tier APM framework, which ties higher tiers to population-based payment rather than per-service billing, as the direction payers and providers should move. The author calls for hospitals, insurers, public payers, providers, and drugmakers to collectively shift toward paying for care coordination and prevention rather than individual services.

State Policy·CA·32d ago

Former California Lawmaker Calls for Unified Health Care Cost Control Strategy

A former California state legislator argues that California's health care system, costing over $400 billion annually, requires a cohesive long-term strategy rather than piecemeal legislative fixes. The author, who helped establish the California Office of Health Care Affordability (OHCA) and the state's all-payer claims database, contends that meaningful cost control demands data transparency, cross-sector coordination, and accountability mechanisms to counter fragmented policy approaches driven by competing interests. The commentary frames affordability as essential to maintaining public trust and access amid state budget pressures and federal funding uncertainty.

State Policy·CA·44d ago

Kaiser Permanente Reports on Implementing California Medi-Cal Doula Benefit

Kaiser Permanente published lessons learned from implementing California's Medi-Cal doula benefit, emphasizing the importance of engaging frontline workers in the integration process. The report covers operational challenges in incorporating doula services into managed care delivery systems. California's doula benefit, added to Medi-Cal in recent years to address maternal health disparities, requires health plans to cover doula services for pregnant members. The experience offers practical guidance for other health plans navigating doula benefit implementation and highlights workforce integration issues relevant to maternal health initiatives in Medicaid.

State Policy·CA·45d ago

California Dual Eligible Enrollees Lose Medi-Cal Coverage Due to Administrative Errors

Administrative and paperwork errors are causing dually eligible beneficiaries in California to lose Medi-Cal coverage, disrupting their access to care. These coverage losses affect beneficiaries who qualify for both Medicare and Medicaid, creating gaps in services and undermining trust in the health care system. The issue highlights ongoing challenges in eligibility redeterminations and enrollment processes for vulnerable populations. State agencies and health plans serving dual eligibles must address procedural barriers that lead to inappropriate disenrollment.

State Policy·CA·52d ago

California Immigrants Drop Medi-Cal Coverage Despite Eligibility Under New Enrollment Rules

California's Medi-Cal program is experiencing enrollment declines among immigrant populations following implementation of new eligibility rules, despite many immigrants remaining eligible for full coverage. Program data show eligible immigrants are not reenrolling due to information gaps and lack of trusted communication channels about continuing coverage. The enrollment drop affects access to care for immigrant Medi-Cal beneficiaries. State agencies and managed care plans face challenges communicating eligibility rules and maintaining enrollment continuity during the transition.

State Policy·CA·55d ago

California Health Foundation Urges Coordinated State Response to Medi-Cal Coverage Losses

California Health Care Foundation's health policy director testified before state lawmakers about millions of Californians losing Medi-Cal coverage and proposed a coordinated statewide response. The testimony addressed the growing uninsured population following what appears to be Medicaid redeterminations or eligibility changes. CHCF recommended state-level interventions to address coverage gaps and re-enrollment barriers. The testimony comes as California grapples with post-pandemic unwinding consequences and seeks policy solutions to stabilize coverage for vulnerable populations.

State Policy·CA·58d ago

California Health Care Foundation Urges Medi-Cal Coverage Protections for Homeless Enrollees

The California Health Care Foundation released recommendations calling for simplified documentation pathways, reduced reporting requirements, and coverage protections for Medi-Cal enrollees experiencing homelessness. The proposals address barriers to maintaining continuous coverage during periods of housing instability. The recommendations target state policymakers and Medi-Cal administrators. The proposals matter for managed care plans serving homeless populations, who face higher disenrollment rates due to documentation and address verification requirements that don't account for housing instability.

State Policy·CA·68d ago

Los Angeles County Seeks Half-Cent Sales Tax to Shield Safety-Net Clinics from Medi-Cal Cuts

Los Angeles County voters will decide in June 2026 whether to approve a half-cent sales tax to generate approximately $1 billion annually for community health clinics. The proposed tax aims to protect safety-net providers from ongoing state Medi-Cal budget reductions and federal funding cuts. If approved, the measure would take effect following the June ballot. The initiative responds to financial pressures threatening clinic operations and access to care for Medi-Cal enrollees who rely on community clinics for primary care, behavioral health, and other essential services.

Managed Care·CA·69d ago

California Managed Care Plans Deploy Chief Health Equity Officers Under Medi-Cal Mandate

Medi-Cal managed care plans are required to employ chief health equity officers as part of California's strategy to address health disparities. These officers are implementing initiatives to reduce inequities in care delivery and outcomes across plan populations. The requirement affects all Medi-Cal MCOs operating in California. This represents a structural shift in how managed care plans address social determinants of health and health equity, requiring dedicated executive leadership and resources for disparities reduction.

State Policy·CA·71d ago

California Medi-Cal Enrollment Drops 5% as 730,000 Disenroll Between June 2025 and March 2026

California's Medi-Cal program lost 730,000 enrollees—a 5% decline—between June 2025 and March 2026, according to California Health Care Foundation data analysis. Undocumented children and young adults experienced disproportionate coverage losses during this period. The enrollment decline follows the end of Medicaid continuous coverage requirements that had kept enrollment elevated during the public health emergency. State agencies and managed care plans should anticipate continued membership volatility and assess impacts on network capacity, risk adjustment, and community-based provider networks serving populations with higher disenrollment rates.

Managed Care·CA·79d ago

Kern Family Health Care Uses AI Outreach to Reduce Medi-Cal Renewal Churn

Kern Family Health Care deployed Careforce AI technology to conduct outreach to thousands of Medi-Cal enrollees at risk of losing coverage during renewals. The AI-powered system identified members who had not completed renewal paperwork and facilitated completion of the process. The initiative helped the health plan reduce disenrollment during California's post-pandemic redetermination period. This represents an operational approach to addressing procedural disenrollment that other Medicaid MCOs may consider as states continue eligibility redeterminations.

State Policy·CA·82d ago

California Defers Medi-Cal Budget Decisions to Incoming Governor

California lawmakers finalized the 2026-27 state budget without resolving major Medi-Cal policy questions, leaving decisions on coverage, workforce, and program financing to the incoming governor who takes office in January 2027. The budget action affects California's Medi-Cal managed care program, which serves over 15 million enrollees through contracted health plans. Deferred issues include provider payment rates, eligibility and enrollment policies, behavioral health funding structures, and workforce development initiatives that directly impact MCO operations and financial performance.

State Policy·CA·82d ago

California Medi-Cal Expands Pre-Release Services for Justice-Involved Enrollees

California's Medi-Cal program is providing pre-release services to individuals exiting jails and prisons, connecting them to health care, housing, and supportive services before release. The initiative targets justice-involved Medicaid enrollees to improve continuity of care and reduce recidivism. Services include care coordination, medication access, and discharge planning while individuals are still incarcerated. The program reflects California's use of federal flexibilities allowing Medicaid coverage up to 90 days before release from correctional facilities.

State Policy·CA·82d ago

California Health Care Foundation Report Examines County-Administered Medicaid Eligibility Friction

The California Health Care Foundation published a paper analyzing structural and programmatic challenges in state-supervised, county-administered Medicaid eligibility systems. The report identifies inefficiencies inherent in the governance model where states oversee eligibility determination but counties execute it, and proposes policy considerations for modernization. This governance structure exists in several states including California, Colorado, Minnesota, New York, North Carolina, North Dakota, Ohio, and Wisconsin. The analysis is relevant for states considering eligibility system reforms and for managed care organizations operating in counties with persistent enrollment and renewal friction.

Federal Policy·CA·87d ago

H.R. 1 Imposes Federal Medicaid Work Requirements, Cuts $1 Trillion Over Decade

In July 2025, President Trump signed H.R. 1 into law, reducing federal Medicaid funding by $1 trillion over ten years and establishing a federal work requirement for certain adult enrollees. The law mandates that covered adults work, attend school, or volunteer to maintain eligibility. The requirements apply to non-exempt adult populations and represent a fundamental shift from prior waiver-based work requirement approaches to a statutory federal mandate. States must implement compliance tracking and reporting systems, affecting MCO enrollment verification, eligibility redeterminations, and coverage continuity processes.

State Policy·CA·87d ago

California Health Care Foundation Publishes Medi-Cal HCBS Fact Sheet Series

The California Health Care Foundation released a fact sheet series explaining the essential components of Medi-Cal Home and Community-Based Services. The series covers how HCBS programs help older adults and people with disabilities live independently in California. The fact sheets are designed as educational resources for stakeholders working with or seeking to understand California's HCBS delivery system. While timing is not specified, this reflects ongoing state efforts to expand community-based alternatives to institutional care under Medicaid.

State Policy·CA·97d ago

California Report Examines Undocumented Residents' Medi-Cal Access Under Enforcement Climate

A California Health Care Foundation report based on interviews with 39 undocumented Californians analyzes how recent Medi-Cal eligibility expansions interact with heightened immigration enforcement concerns. The qualitative research explores coverage enrollment decisions, trust barriers, and healthcare access patterns among undocumented individuals now eligible for Medi-Cal under California's eligibility expansions. The report documents how immigration policy uncertainty affects enrollment behavior and continuity of coverage even when individuals are legally eligible for benefits. Findings inform outreach strategies and enrollment retention efforts for managed care plans serving this population in California.

State Policy·CA·100d ago

California Replaces Mental Health Services Act with New Behavioral Health Services Act

California has replaced the Mental Health Services Act (MHSA) with the Behavioral Health Services Act (BHSA), changing how counties allocate mental health funding. The BHSA modifies funding allocation requirements and county spending priorities for mental health and substance use disorder services. The change affects how counties structure behavioral health programs and redirect existing MHSA revenues. California Health Care Foundation has published resources detailing the differences between the two funding frameworks.

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