Children’s Medi-Cal Managed Care in California Counties

A State and County Analysis of Medi-Cal Managed Care for Children

Poor Managed Care Performance
Puts Children’s Health At Risk

Medi-Cal managed care is the primary mechanism for millions of children in California to receive important preventive and other health services they are entitled to. Yet there is wide variation across the state and even within counties in managed care plan success in ensuring children get the services they need to get or stay healthy. Children Now analyzed county- and plan-level data to develop 58 county landscapes of Medi-Cal managed care for children using county-specific data on Medi-Cal enrollment and children’s access to care, as well as plan-specific information for each county about enrollment, performance and quality, and regulatory compliance with access standards.

This analysis confirms previous studies showing that kids in California are not getting the medically necessary care they need in Medi-Cal, and further found underwhelming rates of preventive services, developmental screenings, asthma control, and children’s access to care across counties in the state. In order to prioritize children’s well-being, we recommend that the state begin to pay Medi-Cal health plans based on their abilities to provide quality care and improve health outcomes for kids – and the health plan procurement process expected to begin in 2020 is an important policy opportunity to do so.

0 %
of two-year olds in Medi-Cal managed care received all their pediatrician-recommended immunization
0 %
of infants and toddlers in Medi-Cal managed care received pediatrician-recommended developmental screenings
0 %
of thirteen-year olds in Medi-Cal managed care received all their recommended immunizations
0 %
of Medi-Cal managed care enrollees ages 5-64 with asthma were dispensed appropriate asthma control medications
0 %
of young children ages 3-6 in Medi-Cal managed care received a well-child check-up – the essential primary care visits for children
0 %
of Medi-Cal managed care families said they could get needed care for children from their health plan

Accountability in managed care performance

Medi-Cal health plans are contractually obligated to provide health care services at minimum levels as measured by a set of quality measures that DHCS identifies each year. Each year, DHCS establishes a High Performance Level (HPL) and Minimum Performance Level (MPL) for each quality measure to which health plans are held accountable. Health plans are contractually required to perform at or above DHCS-established MPLs, and as outlined in guidance, can face corrective action and/or sanctions from DHCS for falling below the MPL. For Reporting Year (RY) 2018, DHCS based the HPLs on the national Medicaid 90th percentiles and the MPLs for RY 2018 on the national Medicaid 25th percentiles. See the table below for a summary of which health plans fell above the HPL (“high-performing”) or below the MPL (“low-performing”) for select child health quality measures.

Medi-Cal health plan performance for children
(Reporting Year 2018)

Two-year old children receiving all immunizations

Plans above the HPL: 79.32%

  • Anthem Blue Cross Partnership Plan (Tulare)
  • Central California Alliance for Health (Monterey and Santa Cruz)
  • Health Plan of San Mateo (San Mateo)
  • Kaiser NorCal (Amador, El Dorado, Placer, and Sacramento)
  • Kaiser SoCal (San Diego)
  • San Francisco Health Plan (San Francisco)

Plans below the MPL: 65.25%

  • Anthem Blue Cross Partnership Plan (San Benito)
  • Anthem Blue Cross Partnership Plan – Region 2 (Alpine, Amador, Calaveras, El Dorado, Inyo, Mariposa, Mono, Nevada, Placer, Tuolumne, and Yuba)
  • California Health & Wellness Plan – Region 2 (Alpine, Amador, Calaveras, El Dorado, Inyo, Mariposa, Mono, Nevada, Placer, Tuolumne, and Yuba)
  • Central California Alliance for Health (Merced)
  • Health Net Community Solutions (Kern)
  • Health Net Community Solutions (Sacramento)
  • Health Net Community Solutions (San Joaquin)
  • Health Net Community Solutions (Stanislaus)
  • Health Plan of San Joaquin (San Joaquin)
  • Health Plan of San Joaquin (Stanislaus)
  • Molina Healthcare of California Partner Plan (Sacramento)
  • Partnership HealthPlan of California – Northeast (Lassen, Modoc, Shasta, Siskiyou, and Trinity)
  • Partnership HealthPlan of California – Northwest (Del Norte and Humboldt )
  • Partnership HealthPlan of California – Southwest (Lake, Marin, Mendocino, and Sonoma)

Young kids receiving a well-child check-up

Plans above the HPL: 82.77%

  • Anthem Blue Cross Partnership Plan (Madera)
  • Anthem Blue Cross Partnership Plan (Tulare)
  • CalOptima (Orange)
  • CalViva Health (Madera)
  • Central California Alliance for Health (Monterey and Santa Cruz)
  • Partnership HealthPlan of California – Southwest (Lake, Marin, Mendocino, and Sonoma)
  • CenCal Health (San Luis Obispo)
  • CenCal Health (Santa Barbara)

Plans below the MPL: 66.18%

  • California Health & Wellness Plan – Region 2 (Alpine, Amador, Calaveras, El Dorado, Inyo, Mariposa, Mono, Nevada, Placer, Tuolumne, and Yuba)
  • Health Net Community Solutions (San Joaquin)
  • Health Net Community Solutions (Stanislaus)
  • Health Plan of San Joaquin (Stanislaus)
  • Partnership HealthPlan of California – Northwest (Del Norte and Humboldt)

Adolescents receiving all immunizations

Plans above the HPL: 30.39%

  • Alameda Alliance for Health (Alameda)
  • Anthem Blue Cross Partnership Plan (Alameda)
  • Anthem Blue Cross Partnership Plan (Contra Costa)
  • Anthem Blue Cross Partnership Plan (Fresno)
  • Anthem Blue Cross Partnership Plan (Madera)
  • Anthem Blue Cross Partnership Plan (Sacramento)
  • Anthem Blue Cross Partnership Plan (San Francisco)
  • Anthem Blue Cross Partnership Plan (Santa Clara)
  • Anthem Blue Cross Partnership Plan (Tulare)
  • California Health & Wellness Plan (Imperial)
  • CalOptima (Orange)
  • CalViva Health (Fresno)
  • CalViva Health (Kings)
  • CalViva Health (Madera)
  • Central California Alliance for Health (Monterey andSanta Cruz)
  • Community Health Group Partnership Plan (San Diego)
  • Contra Costa Health Plan (Contra Costa)
  • Gold Coast Health Plan (Ventura)
  • Health Net Community Solutions (Kern)
  • Health Net Community Solutions (Los Angeles)
  • Health Net Community Solutions (Sacramento)
  • Health Net Community Solutions (San Diego)
  • Health Net Community Solutions (Tulare)
  • Health Plan of San Joaquin (San Joaquin)
  • Health Plan of San Mateo (San Mateo)
  • Kaiser NorCal (Amador, El Dorado, Placer, and Sacramento)
  • Kaiser So Cal (San Diego)
  • Kern Health Systems (Kern)
  • L. A. Care Health Plan (Los Angeles)
  • Molina Healthcare of California Partner Plan (San Diego)
  • Molina Healthcare of California Partner Plan (Riverside and San Bernardino)
  • Molina Healthcare of California Partner Plan (Sacramento)
  • Partnership HealthPlan of California – Southeast (Napa, Solano, and Yolo)
  • Partnership HealthPlan of California – Southwest (Lake, Marin, Mendocino, and Sonoma )
  • San Francisco Health Plan (San Francisco)
  • CenCal Health (Santa Barbara)
  • CenCal Health (San Luis Obispo)
  • Santa Clara Family Health Plan (Santa Clara)

Plans below the MPL: 15.87%

  • Partnership HealthPlan of California –  Northeast (Lassen, Modoc, Shasta, Siskiyou, and Trinity)

Enrollees with asthma who were dispensed appropriate asthma control medications

Plans above the HPL: 72.38%

  • Central California Alliance for Health (Monterey and Santa Cruz)
  • Kaiser NorCal (Amador, El Dorado, Placer, and Sacramento)
  • Kaiser SoCal (San Diego)
  • San Francisco Health Plan (San Francisco)

Plans below the MPL: 55.33%

  • Anthem Blue Cross Partnership Plan (Alameda)
  • Anthem Blue Cross Partnership Plan (Fresno)
  • Anthem Blue Cross Partnership Plan (Sacramento)
  • Anthem Blue Cross Partnership Plan (San Francisco)
  • California Health & Wellness Plan – Region 2 (Alpine, Amador, Calaveras, El Dorado, Inyo, Mariposa, Mono, Nevada, Placer, Tuolumne, and Yuba)
  • Blue Shield of California Promise Health Plan (San Diego)
  • Contra Costa Health Plan (Contra Costa)
  • Gold Coast Health Plan (Ventura)
  • Health Net Community Solutions (Kern)
  • Kern Health Systems (Kern)
  • Partnership HealthPlan of California – Northeast (Lassen, Modoc, Shasta, Siskiyou, and Trinity)
  • Partnership HealthPlan of California – Northwest (Del Norte and Humboldt)

Additional Children’s Medi-Cal Managed Care Data and Resources

Appendix 1:
Medi-Cal managed care models, health plans and payments, by county

Appendix 2:
Medi-Cal rates for select children’s preventive services by county

Appendix 3:
Medi-Cal managed care plan performance on select children’s indicators

Appendix 4:
Children’s Medi-Cal managed care performance / accountability measures for 2020

Medi-Cal Managed Care County Fact Sheet Sources

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