JSI RESOURCES: Publications

Moving Toward Value: Medi-Cal Managed Care Plans and the Social Determinants of Health

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The implementation of the Affordable Care Act and subsequent expansion of Medicaid in California led to dramatic increases in the Medi-Cal population, especially among individuals with more complex needs compared to pre-expansion enrollees. This expansion has led Medi-Cal managed care plans (MCPs) – the dominant model for the delivery of Medicaid benefits in California – to move toward value by considering how social determinants of health affect their members.

To understand the landscape of current social determinants-focused investments in California, JSI surveyed and interviewed plan leaders representing local and commercial MCPs across the state. This report summarizes the key findings that emerged from this engagement, including the factors that drive these types of investments, their funding sources, and the challenges associated with making them. The report also summarizes MCP- and state-level policy, practice, and funding opportunities that would support investments focused on social determinants of health.

A state-level rate adjustment, one of the promising opportunities identified in this report, is further explored in the companion report entitled “A Signal of Support: Exploring Medi-Cal Managed Care Plans’ Perspectives on a Proposed Rate Adjustment.”

This report was made possible with support from Blue Shield of California Foundation. JSI, 2019.

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