This event has been postponed and will be rescheduled soon.

Overview

How is the Medi-Cal program funded?
How does DHCS determine the rates it pays to managed care plans?
How does the state oversee plan finances?

Medi-Cal Managed Care financing is nothing short of complex. Join us for this introductory course and get answers to these questions and more. Expert faculty will discuss:

• How funds flow from the federal and state governments to the plans
• Rate development process
• Regulatory oversight of plan finances
• Special issues in Medi-Cal financing — carve-outs, safety net and other issues
• Emerging issues and challenges in Medicaid financing

Who should attend:
Local health plan staff interested in learning the basics of Medi-Cal Managed Care financing. The course may be most valuable and informative for non-finance staff and staff who are new to managed care finance.

Agenda

*May be subject to change

9:30 a.m. – Noon

Overview: Health Coverage Financing Fundamentals

• The national market for purchasing coverage and how Medicaid fits within it
• Fee-for-service vs. managed care

Key Concepts in Federal & State Financing of Medi-Cal Managed Care

• What is Medicaid and how is it funded?
• How the Medi-Cal program is paid for

How California Pays Medi-Cal Plans: The Rate Development Process

• Key components of the rate development process
• Tools impacting plan payment — base data, efficiency and risk adjustments and more
• Challenges in Medi-Cal rate setting

Noon – 1:00 p.m. | Hosted Luncheon

1:00 – 4:00 p.m.

How State Regulators Oversee Plan Finances

• DHCS and DMHC roles in financial oversight of managed care plans
• Key concepts in oversight — net income, tangible net equity, medical loss ratio, et. al
• What regulators look for in overseeing plan finances
• Plan reporting requirements

Special Issues in Funding Medi-Cal

• Services carved out of Medi-Cal Managed Care
• Special payments to providers

Ask the Experts

In this highly interactive session, participants will have the opportunity to ask our expert faculty about:

• Hot topics in managed care financing
• Potential changes to federal and state policies
• Other burning questions

Site

The California Endowment
1414 K Street, Suite 100
Sacramento, CA 95814

Faculty

Gil Riojas
Chief Financial Officer
Alameda Alliance for Health

Gil Riojas is Chief Financial Officer at Alameda Alliance for Health (Alliance) with responsibility for the overall financial management of the organization. This includes oversight of financial budgeting and forecasting, accounting, financial reporting and other related activities. Prior to joining the Alliance, Gil worked for more than 15 years at the California Department of Managed Health Care where he oversaw the Financial Review Office and was responsible for monitoring the financial solvency and compliance of more than 124 managed care plans statewide.

Meredith Wurden
Consultant and Former Director, Policy and Fiscal Strategy for Partnership HealthPlan of California

Meredith Wurden most recently served as the Director of Policy and Fiscal Strategy at Partnership HealthPlan of California (PHC) where she was responsible for fiscal policy development and communication. Prior to PHC, Meredith worked for the state of California for nearly ten years. She also previously served as Assistant Deputy Director of Health Care Financing at the California Department of Health Care Services and with the California State Legislature covering health issues, including as a principal fiscal and policy analyst for the non-partisan California Legislative Analyst’s Office and as Deputy Director at the California Senate Office of Research. Meredith also worked at the federal Government Accountability Office.

Jonathan Freedman
Vice President
Health Management Associates

Jonathan Freedman works with plans, providers, associations, and governmental and non-governmental entities in the areas of public health, safety net health care, and public policy. His work focuses on strategic planning, public health improvement and transformation, and the health care safety net. Prior to joining HMA, Mr. Freedman held a variety of management and leadership roles at L.A. Care Health Plan and with the County of Los Angeles, and led a number of high-profile health- and health care-related initiatives.

Pete Nakahata
LHPC Institute Advisor
Principal
PTN Consulting

Pete Nakahata is an LHPC Institute Advisor and assists in the development and implementation of the Institute’s training courses and educational programs. Pete is also Principal and Founder of PTN Consulting Group, LLC, a California-based consulting firm that provides professional consulting services to clients on the health insurance exchange and Medicaid managed care related issues. Before returning to consulting, he was a Senior Advisor at CMS’ Center for Consumer Information and Insurance Oversight (CCIIO) and played a critical role in the establishment and operation of both the federally facilitated and State-based exchanges. Pete was also Executive Officer for Strategic Development at CalOptima and part of its original start-up team. He has more than 25 years of experience in government-sponsored and private health coverage, including individual market health insurance, Medicaid managed care, Medicare Advantage and community-based nonprofit health programs.

Registration

NOTE: Health plan staff interested in participating should adhere to their respective plan’s process for LHPC Institute event registration where applicable.

Registration Fees: $30 per registrant

Registration Details: The course will accommodate up to 80 participants. Each plan may elect to send no more than five (5) participants. If more than five individuals from a plan are interested in attending, they are encouraged to sign up for the waitlist. Waitlisted individuals will be admitted should space become available.

Registration Deadline: Registration closes April 2 at 5:00 p.m. or once capacity is reached.

Registration Confirmation: Registrants will receive an email notification confirming their registration.

Presentation Materials: Presentation materials will be made available electronically only via the program resource web page that will be provided to confirmed registrants. Attendees are encouraged to download the materials in advance to their mobile device or print a copy to bring to the event. 

Special Accommodations: Please contact the LHPC Institute at institute@lhpc.org should you require special accommodations pursuant to the Americans with Disabilities Act.

Cancellation and No-Show Policy: Cancellation notification must be submitted in writing to institute@lhpc.org seven or more days prior to the course date. Refunds will not be given after that date. Substitutions are encouraged. Payment will be due for registered individuals that do not attend the event and for which a cancellation notice is not received.