Evaluating California’s Medicaid Managed Care Transition Waiver

Problem

California is limiting Medicaid managed care plan choices to improve access and oversight.

The California Department of Health Care Services (DHCS) is implementing a major restructuring of its Medi-Cal managed care system through the CalAIM Section 1115 Demonstration. This transition limits managed care plan choices in metro, large metro, and urban counties to simplify administration, align benefits, and strengthen oversight.

DHCS wants to understand how these changes affect access to services, continuity of care, and quality of care for Medicaid beneficiaries. The evaluation is part of a broader effort to ensure that Medi-Cal reforms support equitable, person-centered care and improve health outcomes for California’s most vulnerable populations.

Solution

NORC is evaluating the effects of the managed care transition on beneficiaries, providers, and plans.

NORC is conducting a rigorous mixed-methods evaluation of the Managed Care Plan (MCP) Transition Amendment, focusing on its impact on access, quality, and continuity of care. The evaluation includes quantitative analysis of claims, encounter data, and provider network adequacy, as well as qualitative interviews with health plan officials, providers, and Medi-Cal members. NORC is also reviewing MCP reports and financial data to assess administrative complexity and plan accountability. This work builds on NORC’s extensive experience evaluating Medicaid demonstrations and alternative payment models, and leverages its expertise in analyzing complex health data to inform policy decisions.

Result

Our findings will highlight how limits on Medi-Cal plan choice affect access, care continuity, and program oversight.

This evaluation will generate evidence on how limiting managed care plan choices affects Medicaid beneficiaries’ access to services, continuity of care, and care quality in California’s urban areas. Findings will include qualitative insights from providers, health plans, and enrollees on the administrative complexity of the transition, along with quantitative analysis of claims and encounter data. The project will also inform oversight efforts by analyzing managed care plan reports and financial data. Results will support DHCS in refining Medi-Cal policies and improving managed care program alignment statewide.