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County’s largest Medi-Cal plan on state’s chopping block

Community Health Group is San Diego county’s only locally based Medi-Cal health plan and serves 36 percent of the area’s Medi-Cal recipients, the most of any plan operating in the region. A recent decision by the California Department of Health Care Services would eliminate the ability of San Diego’s largest Medi-Cal health plan to serve the region. This would result in disrupting Medi-Cal services for 335,000 low-income San Diegans in January 2024 if the state does not renew CHG.

The state announced in August it was restructuring its managed care plans for Medi-Cal providers and went from seven to three providers, awarding Molina Healthcare, Health Net, and Kaiser Permanente.

A crowd of more than 70 residents, health care professionals, and Chula Vista Mayor Mary Casillas Salas held a press conference Sept. 29, to speak out against the state’s proposal, which affects the entire county.

“Our neighbors trust Community Health Group and we will fight to make sure they can keep serving the most vulnerable,” said Salas in a press release. “They are based here in our community and employ people in our community. They keep our economy strong and our people healthy. If the state does not add them back as a health plan it will increase inequities and worsen health outcomes in our communities.”

CHG COO Joseph Garcia said 99% of its business is Medi-Cal programs, so if the state does not allow it to operate, it would have to look for other opportunities to serve between now and January 2024.

“We are not focused on that future Jan. 1, 2024,” he said. “Right now, we are focused on the appeal and possible litigation, and trying to get the state to overturn their decision. Or maybe not overturn it, but at a minimum, add us as an additional plan. That is our focus. That was the purpose of the press conference. That is the purpose of getting the community to support us. So, all of our energy right now is in that.”

Garcia said the focus is winning this battle and continuing to serve the Medi-Cal population beyond January 2024.

Garcia said CHG is not ready to discuss the “what if” if the state keeps its decision final.

“Our assumption is that we are going to win this,” he said. “And we are going to focus our energy in winning this battle with the Department of Health Care Services.”

Garcia said the state is saying the reason they are doing this is that is to improve the quality and accessibility for Medi-Cal recipients in San Diego County and other counties across the state.

“We all applaud. We agree. However, we also know, that we, Community Health Group have the highest quality scores in the county. We have the largest network of primary care and specialty care physicians. We have the highest timely accessibility scores in the state. We have the highest preventive scores for children scores in the state. These are public metrics, not CHG metrics. Some of them are from the Department of Healthcare Services, some of them are from Department of Managed Healthcare, and others from independent third-party reports. So, if they want the best, we are the best. We are way above in terms of those scores than the plans that were chosen. That is why this does not make any sense to us. On the one hand, they want the best, and on the other hand, they get much less than the best.”

DCHS spokesperson Anthony Cava told KPBS on Sept. 30, that Community Health Group was not among the two top scoring plans for San Diego County,

“However, as you are aware, the intended awards are currently the subject of appeals.”

Garcia said there are 56 plans in the state of California.

“So, they can say we are not the top two, that is correct out of 56 plans in the state, we are number four,” he said.

La Maestra Community Health Centers President and CEO Dr. Zara Marselian said CHG is the largest health plan that serves Medi-Cal in San Diego with around 335,000 members, and if they are not selected and go away, 335,000 patients will have to transfer to another health plan.

Doctors and patients expressed concern at the news conference that the state’s choice will spur major disruption and confusion for the sick and elderly, harm low-income families, reduce equity, and worsen access to healthcare for Medi-Cal recipients. The public can visit for more information.

County’s largest Medi-Cal plan on state’s chopping block

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Source: East County Californian

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