Medi-Cal: enhanced care management and community supports.

Senator Menjivar's legislation aims to strengthen Medi-Cal's enhanced care management (ECM) benefit and community supports by establishing new requirements for managed care plan contracting with local providers. The bill mandates that Medi-Cal managed care plans contract with community providers who demonstrate capability in delivering ECM services and community supports, while allowing plans to consider provider availability and experience within their counties.

The legislation introduces biennial goal-setting requirements for managed care plans regarding their utilization of community providers and local entities. Plans must establish these targets in consultation with the Department of Health Care Services, which will monitor compliance through new quarterly public reporting requirements. These reports will detail service utilization and demographic data across provider types, including for-profit entities, local governments, and community providers.

To facilitate implementation, the Department must develop standardized contracting templates and guidance enabling community providers to serve as primary subcontractors while maintaining relationships with other local organizations. The bill preserves managed care plans' ability to contract with various provider types and maintain some ECM services internally, provided they demonstrate appropriate community-based delivery. When eligible members are referred by contracted community providers, plans must assign members to those providers if they can appropriately meet member needs.

The legislation maintains the existing framework of ECM target populations, including children with complex needs, individuals experiencing homelessness, high healthcare utilizers, and those transitioning from incarceration. It also preserves the voluntary nature of community supports like housing services, nutrition assistance, and recuperative care, while requiring transparent documentation of available services in member materials.