The Contra Costa Health Plan (CCHP) currently operates in a “Two-Plan Model” county. The two plans are CCHP and Anthem Blue Cross. Currently CCHP has approximately 84% of the Medi-Cal membership and Anthem Blue Cross has approximately 16%.
An option for CCHP is to convert to a single plan model known as a County Organized Health System (COHS). The COHS model provides a number of benefits for the County’s Medi-Cal population: (a) enhances the probability of success in the State’s CalAIM initiatives (b) provides the pathway for full Medi-Cal population health initiatives (c) opens possibilities for better management for those transitioning out of incarceration (d) allows for consideration of a fully integrated model inclusive of behavioral health and long-term care and (e) the single plan structure is a cost effective alternative.
The Contra Costa County Board of Supervisors is currently the governing body of CCHP. Conversion to a COHS is expected to have no impact on the current governance or organizational structure.
Conversion from a two plan to a single plan model requires the State Department of Health Care Services (DHCS) approval, a new County Ordinance, Federal approval of a section 1115 Waiver or other waiver for the creation of a new COHS, and execution of the implementing single plan model managed care plan (MCP) contract with DHCS.
The State timeline for model conversion consideration is as follows:
a. Letter of intent approved by the Board by April 30, 2021 (approved by the Board on April 27, 2021 and submitted to the State).
b. CCHP to submit documentation for preliminary planning for a network contracting strategy and ongoing negotiations to support the increased capacity necessary for the local plan responsibility for January 2024 by September 1, 2021 (completed and submitted on August 16, 2021).
c. County Ordinance adoption by October 1, 2021 (Adopted by the Board on September 14, 2021).
d. State legislative action, if needed, by September 10, 2021 (this step is not required for CCHP).
e. After October 19, 2021 Final Commercial Plan RFP release.
f. 2021-2022 DHCS will work with federal Centers for Medicare and Medicaid Services (CMS) for necessary waiver amendments and other approvals.
g. January 2024 new contracts and plans begin.
On March 12, 2021 the Contra Costa Health Plan Joint Conference Committee received and reviewed the option for a CCHP conversion to a single plan model. Supervisors Andersen and Glover are voting members on the Committee, which approved the concept and recommended forwarding the submission to the full County Board of Supervisors for approval.
On April 27, 2021 the County Board of Supervisors accepted the concept introduced by the Contra Costa Health Plan at the March 12, 2021 Joint Conference Committee Meeting to convert CCHP from a Medi-Cal two plan model to a single plan model known as a County Organized Health System (COHS), and authorized the Chair of the Board and the Contra Costa Health Plan (CCHP) CEO to sign a non-binding letter of intent to the State of California.
As a condition of moving forward to a single plan model the State is requiring an ordinance for any County that is seeking a model change. The State considers the public review process and other aspects of an ordinance important for the interests of Medi-Cal beneficiaries regarding a potential change of this type. Accordingly, an ordinance has been drafted to comply with the State’s requirement. The ordinance stipulates that the “Contra Costa Health Plan is authorized to serve as the single local plan for Medi-Cal managed care enrollees in the County upon approval of the California Department of Health Care Services”.
On September 7, 2021, the Board introduced Ordinance No. 2021-31, authorizing the Contra Costa Health Plan to serve as the single local plan for Medi-Cal managed care enrollees in the County commencing on January 1, 2024, waiving the reading, and fixing September 14, 2021, for adoption. Ordinance No. 2021-31 was adopted on September 14, 2021.
Ordinance No. 2021- 42 repeals Ordinance No. 2021-31, which was adopted by the Board on September 14, 2021. The State requested that the following be added to the ordinance: “The effective date of this authorization is January 1, 2024, unless the California Department of Health Services approves and authorizes a different date.” On December 7, 2021, the Board introduced Ordinance No. 2021-42, authorizing the Contra Costa Health Plan to serve as the single local plan for Medi-Cal managed care enrollees in the County commencing on January 1, 2024, waiving the reading, and fixing December 14, 2021, for adoption.
The County’s obligation to implement the single plan model ultimately is dependent upon DHCS’ acceptance of CCHP’s submitted documentation and network contracting strategy, the receipt of all necessary federal approvals, and execution of the Medi-Cal MCP contract with DHCS for a single plan model.
Failure to adopt this ordinance will eliminate CCHP from the State's model conversion consideration.