February 4, 2022

Expanding Medi-Cal enrollment, improving quality

Kaiser Permanente, state of California reach agreement to cover more people in need.

As a nonprofit health care organization with a mission to provide high-quality care and coverage — and to improve the health of our communities — Kaiser Permanente has participated in Medicaid for decades. Through this work the organization helps improve access to health care among people who otherwise cannot afford the care they need, including Kaiser Permanente members who lose their employer-sponsored coverage due to job loss.

In California, where more than two-thirds of Kaiser Permanente Medicaid members live (and the program is called Medi-Cal), it has been challenging to offer this coverage to more people who could benefit from it. Because Kaiser Permanente is both a health plan and a care provider, our care delivery system must have providers, facilities, and other infrastructure in place to enroll and serve more members, including Medi-Cal members. In addition, Medi-Cal’s very low reimbursement rate and unique limits on the number of plans that can offer coverage have combined to limit our ability to expand our Medi-Cal enrollment.

Kaiser Permanente is continuing our commitment to provide care and coverage to more Medi-Cal beneficiaries, and we believe we can improve quality of care for an even larger number of Medi-Cal beneficiaries by helping the safety net system. The goal is not for Kaiser Permanente to compete with the safety net but to support it.

Today, the state of California announced a new agreement with Kaiser Permanente. The 5-year state contract would allow Kaiser Permanente to provide Medi-Cal coverage to more people, improve quality for a broader number of beneficiaries including those covered by other plans, increase the stability and quality of care of the safety net system, and provide additional value beyond these benefits.

Through this joint agreement, Kaiser Permanente and the state will develop sustainable approaches to increase participation in Medi-Cal and improve the program in a variety of ways. Following are key elements of this agreement.

  • Enrollment growth – Currently, Kaiser Permanente serves Medi-Cal beneficiaries who were covered through one of its commercial plans or Medicare, or who have family members with such coverage. This is called continuity of care and coverage. Through this new agreement, Kaiser Permanente will focus primarily on this continuity of care and coverage, as well as children in foster care and our members who are also eligible for Medicare, as we look to increase Medi-Cal membership in a sustainable way, in line with our growth in other enrollment.
  • Population health – Kaiser Permanente is proposing to support the safety net by bringing its population health model to the Federally Qualified Health Centers to help improve quality across the state. An independent study published by the California Health Care Foundation found that Kaiser Permanente year in and year out is the highest performing health care plan for Medi-Cal beneficiaries. In fact, through its subcontracts with other health plans, Kaiser Permanente’s results improve the quality scores of those other plans. 
  • Virtual care – As virtual care services continue to improve and evolve, Kaiser Permanente will be looking at ways to help expand the FQHCs’ virtual clinical and knowledge capacity so they can do more to help more people.
  • Specialty care gaps – We will be addressing identified gaps in specialty access by piloting a limited number of in-person, ambulatory based, outpatient specialty care visits for the highest need specialties. This will add to the safety net system, not take away from existing services.

Kaiser Permanente is also committed to the Department of Health Care Services CalAIM initiative, a multiyear initiative to improve the quality of life and health outcomes of the Medi-Cal population by providing enhanced care management and community supports in alignment with other Medi-Cal managed care plans. In short, CalAIM is about whole person care, improving quality, and administrative simplification. This agreement advances all 3 goals, which is one of the reasons DHCS is making this change. 

This agreement will make the Medi-Cal program easier for our members to use. It allows Kaiser Permanente members to keep their providers more easily if they ever need to join Medi-Cal. Further, serving our Medi-Cal membership under this single contract will be a consumer-friendly improvement to members’ Medi-Cal experiences, by ensuring continuity of care and reducing member confusion associated with the current model.

This agreement will allow Kaiser Permanente to care for more people with Medi-Cal in a way that is sustainable, valuable to the people who need this important coverage, and supportive of the existing safety net, and does not exceed Kaiser Permanente’s delivery system capacity nor resources.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 12.5 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health.