Medi-Cal: enhanced care management and community supports.

Senator Menjivar's proposed changes to California's Medi-Cal program would require managed care plans to prioritize contracting with community providers for enhanced care management services and community supports. The legislation modifies existing requirements under the California Advancing and Innovating Medi-Cal (CalAIM) initiative, which provides whole-person care services to specific populations including homeless individuals, high healthcare utilizers, and those with serious mental illness.

The Department of Health Care Services would develop standardized contracting templates to facilitate partnerships between managed care plans and community providers - defined as locally-governed nonprofits with direct experience serving Medi-Cal populations. The department would also establish annual rate guidance based on actual service costs, including administrative expenses like referral outreach and documentation. Community providers would gain the ability to subcontract with other local organizations to deliver services.

The bill maintains existing provisions allowing Medi-Cal managed care plans to cover approved community supports like housing navigation, medical respite care, and medically-tailored meals. Plans must publicly post information about available supports and any limitations. The department would conduct independent evaluations of these services' effectiveness according to CalAIM terms and conditions while publishing annual utilization and demographic data.