California's Medicaid managed care legislation established a “two-plan” model in the twelve counties with the largest Medicaid populations. Medicaid recipients can choose between a “Local Initiative” and a commercial plan. The Local Initiative was the state’s effort to help traditional safety net providers compete to retain Medicaid patients. In Los Angeles County, L.A. Care Health Plan was established as the Local Initiative.
L.A. Care is a local Health Authority—a distinct unit of government for which the County has no financial or other liability. It was designed as a public/private partnership in which L.A. Care arranges for the provision ofhealth services through its contracts with six commercial HMOs and one County HMO. It is not provider-sponsored.
The presentation will focus on challeges faced from the environment in which LA Care operates. For example, the "two plan" enabling legislation places special requirements on the local initiative plans, such as adherence to public entity laws, the appointment of a stakeholder board at times constrained by conflict of interest issues, and mandated contracting with the safety net and traditional Medicaid providers.
There is a tension between insulating the safety net from market forces and helping it compete for commercial populations. The public/ private partnership model is challenged by contract-based accountability, variability in performance among plans, the need to reconcile the business and safety net cultures, and the potential impact of declining Medi-Cal enrollment. Finally, there is a tension between involving the community and the limits of an advisory role.
Learning Objectives: 1) Understand the distinctive roles and dilemmas of public managed care plans. 2) Understand how these plans have been used as a tool for protecting the financial viability of public hospitals and other safety net providers. 3) Evaluate their effectiveness in carrying out that role. 4) Compare the organization and strategies of different public managed care plans. 5) Examine how the plans are affected by their local environments
Keywords: Managed Care, Public Hospitals
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.