Kaiser Contract Update

The Newsom Administration has released proposed budget trailer bill language that: 1) details how individuals can enroll in Kaiser, 2) permits the DHCS to contract with Kaiser in any geographic region of the state, and 3) allows the DHCS to seek any federal approvals necessary to implement.
 
Under the proposed language, the following beneficiary populations enrolling in Medi-Cal managed care would be eligible to enroll, or chose to maintain their enrollment, in Kaiser: 

  • A beneficiary who was previously enrolled in Kaiser as their primary Medi-Cal managed care plan on or before December 31, 2023;
  • An existing member of Kaiser who is transitioning into Medi-Cal managed care;
  • A beneficiary who was a member of Kaiser at any time during the 12 months immediately preceding the effective date of the beneficiary’s Medi-Cal eligibility;
  • A beneficiary with Kaiser family member linkage;
  • A beneficiary who was previously enrolled in a primary Medi-Cal managed care plan other than the Kaiser on or before December 31, 2023, but who was assigned to and made the responsibility of the Kaiser under a subcontract with the aforementioned Medi-Cal managed care plan;
  • A dual eligible beneficiary residing in a geographic region approved by the Department for this specific purpose;
  • A beneficiary eligible on the basis of their receipt of services through a state foster care program.

For more on this read here: 5 QUESTIONS: HOW KAISER PERMANENTE’S NO-BID DEAL MAY AFFECT CALAIM.

Lots more to come on this. We will keep you posted.

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