We believe that the Department of Health Care Services has a duty to get this right and not just rubber stamp its original decision.”īlue Shield also noted that the state-appointed hearing officer is an employee from the Information Management Division. “On behalf of the Medi-Cal beneficiaries we serve today whose health care is directly impacted by this decision, and of every Californian, we are turning to the court to insist on a full, fair, and robust Medi-Cal procurement appeals process. “We have waited in good faith and the Department of Health Care Services is refusing to provide the public information we are requesting or to provide a reasonable amount of time for the appeal process,” she stated in a press release. Kristen Cerf, President and CEO of Blue Shield of California Promise Health Plan, expressed the plan’s frustration on the matter. The plan states that DHCS has not provided the requested documents and that the hearing officer has denied the request for additional time. Health Net’s parent company Centene Corporation, however, is voicing their opposition to DHCS’s decision to not specifically contract with them in Los Angeles, Sacramento, and Kern counties once the new contracts begin.īlue Shield alleges DHCS violated the state public records act by refusing to produce documents on the scoring process, methodology, and communications related to the awarding of contracts for 2024.īlue Shield claims it submitted a request for public records to the state as part of the appeals process, and that it also requested more time for the appeals process from the state-appointed hearing officer. Health Net will operate in Amador, Calaveras, Inyo, Mono, San Diego, San Joaquin, Stanislaus, Tulare, and Tuolumne counties. Molina Healthcare will operate in Los Angeles, Riverside, San Bernardino, Sacramento, and San Diego counties.Īnthem Blue Cross Partnership Plan will operate in Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Madera, Mono, Santa Clara, San Francisco, Sacramento, and Tuolumne counties. The awarded health plans include Molina Healthcare, Anthem Blue Cross Partnership Plan, and Health Net. 1st, 2024, to 3 commercial managed care plans to deliver Medi-Cal services in 21 counties across the state. 30th, requested to deny appeals to the state’s Medi-Cal managed care awards, including appeals filed by Blue Shield, CVS/Aetna, Community Health Group, and Centene/Health Net.ĭHCS awarded 28 contracts, all beginning Jan. Through this procurement, DHCS did not award Blue Shield or Community Health Group a contract in any county, and did not award Health Net a contract in Los Angeles, Sacramento, or Kern counties.
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