(Monning) Floor: 23-43-14
More than 80% of Californians with Medi-Cal receive healthcare through a Medi-Cal health plan. There are different models of Medi-Cal managed care in each county. One of those models is the County Organized Health System (COHS), which consists of plans created or authorized by the county board of supervisors to serve as the county’s plan for all Medi-Cal consumers in the county. Other Medi-Cal managed care plans are licensed by the Department of Managed Health Care under the Knox-Keene Act, which provides major consumer protections, but COHS plans are not. Some of the protections granted to DMHC-licensed plans that are not granted to COHS plans are: the option to appeal denials of care to independent medical experts; an external DMHC review to dispute whether a service is a covered benefit; and the continuation of consumer care from out-of-network providers. SB260 would have ensured greater equity by removing the COHS exemption to Knox-Keene consumer protections.