The HMO blew two deadlines to supply information required by the state to monitor Medi-Cal managed care plans. Kaiser says it is “taking steps” to resolve the problem.
Medi-Cal’s controversial program to go after your assets when you die will be significantly curtailed, but some enrollees could be hit by new claims.
Private insurers that administer Medicaid for the poor also face limits on profits and requirements to provide sufficient doctors.
As officials seek to take control of costs in the health coverage for low-income residents, they are relying on hospitals, not private insurance companies, to run the program.
The proposed compromise would avert $1 billion in budget cuts but still must be approved by a two-thirds majority in the legislature.
Federal policy requires that California broaden taxes on insurers to fund Medicaid, but state insurers and many Republican legislators are opposed.
About 47 percent opt out of California’s “dual eligibles” program serving Medicare and Medicaid patients, in part because they fear losing their doctors, a survey finds. But once enrolled in the pilot program, most stay.
With legislation that passed last month, North Carolina is trying to build a hybrid managed care, accountable care model – with doctors, hospitals and insurance companies all sharing some risk. Advocates worry it could eclipse gains made by Medicaid in the state in the past.