Latest, page 4
- Published Oct 5
CenCal Health Funds $2M Medi-Cal Navigation Hub for Central Coast
CenCal Health, the Medi-Cal managed care plan for Santa Barbara and San Luis Obispo counties, has launched Central Coast Coverage, a $2 million regional navigation hub built with community partners to help members keep Medi-Cal coverage through upcoming eligibility changes. The hub offers one-on-one assistance, multilingual resources and help completing renewal forms, and is being run through grants to Family Service Agency and other local organizations. County estimates show up to 44,000 residents are at risk of losing coverage, with 18,000 already disenrolled since August 2025, disproportionately working-age adults. The effort is timed ahead of 2027 federal and state changes expected to bring more frequent renewals and new work and community service requirements.
Why it mattersFor Medi-Cal MCOs and county agencies, proactive renewal navigation is becoming a key strategy to limit coverage churn and avoid downstream cost and access pressures as stricter eligibility rules take effect in 2027.
- Published Oct 2
HPSJ Launches Provider Training to Improve PCP Encounter Data
Health Plan of San Joaquin/Mountain Valley Health Plan notified capitated primary care providers that it is overhauling encounter submission processes tied to its PCP capitation rate methodology. The plan set new PCP capitation rates in December 2024 based on encounter and claims utilization and plans to reevaluate rates annually using that data, making accurate submission directly tied to reimbursement. Providers can expect a follow-up on capitation rate details later in October 2026, a Q&A session in November, and ongoing training, education resources, and monitoring to address common submission errors. The initiative also supports HEDIS performance and quality outcome reporting for the Medi-Cal managed care plan.
Why it mattersCapitated PCPs whose future reimbursement rates depend on encounter data accuracy must engage with the new training to avoid underpayment from incomplete or inaccurate submissions.
- Published Oct 2
- Published Oct 2
CMA, CAHP Sue California Over Managed Care Organization Tax
The California Medical Association and the California Association of Health Plans filed suit with the California Supreme Court challenging the state's Managed Care Organization tax. The groups argue the tax violates the state constitution, circumvents Proposition 35, exceeds voter-approved limits on taxing health insurance coverage, and fails to spend revenue as Prop 35 requires. The lawsuit targets how California structures and directs proceeds from the MCO tax, a key funding source for the state's Medicaid program. No ruling date was specified in the filing announcement.
Why it mattersA successful challenge could upend California's MCO tax revenue stream used to help fund Medi-Cal provider payments and plan financing, forcing the state to rework its Medicaid budget.
- Published Oct 1
Report: Medicaid Cuts, ACA Premium Hikes Threaten Rural Hospitals
American Community Media reports that hundreds of rural hospitals across the country face closure as a combination of Medicaid funding cuts and rising ACA marketplace premiums pushes more Americans into the ranks of the uninsured. Rural hospitals, which rely heavily on Medicaid reimbursement and already operate on thin margins, are described as especially vulnerable to reduced federal support and declining coverage. The piece frames the risk as part of a broader healthcare affordability crisis affecting low-income and rural populations. No specific federal action, legislation, or timeline is detailed in the source beyond the general trend.
Why it mattersState Medicaid agencies and rural providers face mounting financial exposure as reduced Medicaid funding and coverage losses threaten the viability of safety-net hospitals serving Medicaid beneficiaries.
- Published Oct 1
CANHR Issues Fact Sheet as Health Net Ends ALFT Services
CANHR has released a consumer fact sheet responding to Health Net's plan to terminate its Assisted Living Facility Transitions (ALFT) program by December 31, 2026. ALFT helps high-needs, low-income Medi-Cal beneficiaries cover additional costs of residing in assisted living facilities instead of more expensive skilled nursing care. Health Net has not reversed its decision despite pushback, leaving affected members needing to plan alternative placement and services before funding ends. The fact sheet outlines service options, considerations, and consumer rights for those impacted.
Why it mattersMedi-Cal beneficiaries relying on ALFT face a hard funding cutoff that could force transitions to costlier or less appropriate care settings if alternatives aren't secured before year-end.
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