2024 DHCS Medi-Cal Contract Transition – Counties Health Net will no longer serve

23-158e

Counties

• Kern
• Riverside
• San Bernardino
• San Diego

2024 DHCS Medi-Cal Contract Award Q&As

1. What happened to the RFP?
   DHCS has formally canceled the RFP and is using its authority to issue direct contracts on a county-by-county basis.
2. How long is the new contract?
   The contract will be five years, through December 31, 2028, auto-renewing at the end of each year for the next year.
3. What counties will Health Net no longer serve as of January 1, 2024?
   Health Net proudly serves individuals and families across California through our Medicare, Medi-Cal and Commercial lines of business. While the DHCS announcement means Health Net will no longer serve Medi-Cal members in counties in the rural north part of the state that will be converting to new Managed Care models in 2024, or Kern and San Diego counties, there are no impacts to our Medicare or Commercial lines of business in those areas. We remain steadfast in our commitment to partner with incoming Medi-Cal health plans to facilitate successful transitions. More information on transition plans will be provided soon.
4. Does my provider agreement need to end if Health Net exits a county on January 1, 2024?
   No.
5. What happens if the replacement plan in my county doesn't meet operational readiness requirements by January 1, 2024?
   Operational readiness is required effective January 1, 2024. DHCS reserves the right to extend contracts with existing plans should new plans require additional time to meet required readiness requirements.
6. Do I need to cancel or amend my contract with Health Net if Health Net no longer serves Medi-Cal members in my county?
   If Health Net will no longer serve Medi-Cal members in your county, you don't need to do anything and your agreement can continue. If changes are needed to your agreement, your assigned Regional Network Director from Health Net will contact you. Please note that Health Net may still serve commercial and/or Medicare members in your county and your agreement may still cover those members. Additionally, if you are located in a county that is contiguous (sharing a common border) to a county that Health Net serves for Medi-Cal, you may end up serving Health Net’s Medi-Cal members from the neighboring county.
7. Describe the member transfer process when Health Net is the transferring plan. Can Health Net block transfer a provider's Medi-Cal members to the health plan they chose (CHG or BlueShield Promise)?
   No. DHCS will transition the members.
8. What percentage of the membership will be awarded to each health plan (CHG & BlueShield)?
   If historical practice is any indication, we will not know until the transition is complete. DHCS will assign a member to a provider and health plan if the member does not select one. This assignment process is not expected to happen until later in 2023.
9. Will the DHCS provide additional funding to subsidize cost increases for the health plans, and will this funding be passed down to the IPAs to maintain cost neutrality?
   DHCS is required to set actuarily sound rates. Program and benefit changes are considered in the process. Rates are evaluated annually. Provider must engage in negotiations with their respective health plans as part of their normal negotiation cycles.
10.   Added December 7, 2023 – What happens to claims that span from 2023 into 2024, specifically for inpatient hospital visits?
    The responsibility is determined by the date-of-service and authorization timeframe.
    
    If a claim has a date of service on or before December 31, 2023, Health Net will be responsible for payment of appropriate claims if prior authorization approval is in place. Please send these claims to:
    
    Health Net Community Solutions, Inc.
    Medi-Cal Claims
    P.O. Box 9020
    Farmington, MO 63640-9020
    
    Claims with a date of service on or after January 1, 2024, will be denied by Health Net. The new health plan will be responsible for payment of appropriate claims with a date of service on or after January 1, 2024. Please submit these claims to the new Medi-Cal plan. 
11. Who do I submit questions to or contact if I need additional information?
    If you have additional questions or need additional information you can reach out to your Regional Network Director in Provider Network Management.