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Managed‑care to fee‑for‑service shift raises eligibility concerns; premium subsidies to reach about 200,000 more people
Summary
Committee members asked whether shifting a population from managed care to fee‑for‑service would affect undocumented immigrants' access to managed‑care benefits. The Director said those managed‑care benefits would not be part of fee‑for‑service; the Director also estimated about 200,000 additional individuals would be eligible for premium subsidies up to 200% of the federal poverty level.
Committee members raised concerns about the implications of moving a UIS population from managed care to fee‑for‑service. One committee member asked whether the change would mean undocumented immigrants in Medi‑Cal would no longer be eligible for managed‑care benefits such as Enhanced Care Management (ECM) or community supports. The Director responded that ECM and community supports are managed‑care benefits and "would not be part of the fee for fee for service structure," indicating those benefits would not be provided through fee‑for‑service.
Why this matters: The change could alter which services are available to particular enrollees depending on program design; the Director’s answer flagged a practical effect of the programmatic shift, though the transcript does not record an alternate delivery pathway or mitigation plan for affected enrollees.
The Director also addressed premium subsidy changes, saying about 200,000 additional individuals would become eligible for subsidies and that eligibility would extend up to 200% of the federal poverty level. The Director did not provide an income‑bracket breakdown during the briefing and said staff (Lupe) would follow up.
Committee members asked whether the administration would submit waiver drafts (11‑15 and 19‑15(b)) to include community supports and how those waivers interact with the managed‑care changes; the Director said follow‑up would be provided and that January proposals remain under discussion with stakeholders.
The briefing noted no formal policy adoption during the session; the administration said it will provide follow‑up details on waiver drafts and subsidy income brackets.
