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HHS Releases Rate Differentials Between Medi-Cal and Healthy Families

The State Health and Human Services Agency (HHS) released a document outlining the rate differentials between Medi-Cal and Healthy Families, with an explanation on why the rate change will not lead to disruptions in provider/plan participation.

Highlights:

  • Medi-Cal provides protection for out-of-network services to be reimbursed at Medi-Cal rates instead of commercial rates (as is the case for HF)
  • Medi-Cal offers rate protection to allow plans to contract at Medi-Cal rates instead of commercial rates
  • Plans no longer responsible for mental health benefits since they are fully carved out in Medi-Cal
  • Any increase in managed care organization (MCO) tax resulting from plan transitions to be returned to plans in the form of rate increases (primary care), which will be federally matched 2:1
  • Between January 1, 2013 and December 31, 2014, the federal government provides 100% of reimbursement for the cost of increasing primary care provider rates to 100% of Medicare

The document is available for download here.

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