California’s state budget situation continues to deteriorate- threatening coverage, benefits, and the affordability of healthcare.   Health plans worked in partnership with the Department of Health Care Services to improve program efficiencies and reduce waste in the Medi-Cal program. Unfortunately, California continued efforts to limit Medi-Cal coverage and benefits for undocumented residents.   

Health plans worked with Covered California to keep as many Californians covered as possible. However, the state chose to increase premiums by $1.5 billion by enacting a health care tax making it more expensive for folks to purchase coverage.   Federal changes and reductions in support for Medi-Cal and Covered California continue to raise new challenges for health plans and enrollees to access coverage. 

California policymakers continue to say that “affordability” is important to them, however time and time again they pass new laws and taxes that increase the cost of living. Meanwhile the Office of Health Care Affordability is tasked with lowering healthcare costs. Health plans are caught in the middle.  

The Medi-Cal program is looking to change the delivery of “Enhanced Care Management”, find further costs savings across the program, and maintain enrollment. These challenges paint a picture of a future where plans need to work with less resources, with new partners, and with new challenges. Meanwhile, a new benefit for IVF treatment rolled out in the large group market. 

The California Legislature once again considered a large number of bills that would increase health care premiums.  Hot topics included prior authorization, access, benefit mandates, and drug costs.  

 Join over 1,200 other health care professionals to learn how health plans in California are dealing with changes and taking on new responsibilities.