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Managed Care
Since the mid-1990s, the California Medical Assistance Commission has negotiated the Department of Health Care Services’ contracts with two Geographic Managed Care (GMC) programs.
GMC is a Medi-Cal managed care model designed to provide a comprehensive program of managed care with maximum access by allowing Medi-Cal beneficiaries, in clearly defined geographical areas of the State, to choose among competing commercial health maintenance organizations (HMOs), see Welfare and Institutions Code section 14089.
The California Medical Assistance Commission negotiates contract rates, terms and conditions for Medi-Cal contracts between the competing HMOs and the Department of Health Care Services for a standard benefit package. There are two GMC programs currently operating in California:
- Sacramento Geographic Managed Care; and
- Healthy San Diego.
In fiscal year 2006-07, the estimated State General Fund savings due to managed care rate negotiations is estimated to be $300.0 million. Since fiscal year 1995-96, the accumulated State General Fund annual savings associated with managed care rate negotiations is estimated to be in excess of $1.4 billion.