Session 1  |  March 18, 2025
Session 2  |  March 24, 2025
1:30 – 3:00 p.m., Pacific Time
An LHPC members-only program

Overview

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

Medi-Cal managed care financing is nothing short of complex. Join us for this introductory webinar series and get answers to these questions and more. Expert faculty will discuss:

• Key concepts in federal and state financing of Medi-Cal and managed care
• How Medi-Cal managed care plans are paid
• Data used to develop rates
• Key components of the rate development process
• And more …

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

Session 1

Key Concepts in Medi-Cal Managed Care Financing &
Introduction to Rate Setting
March 18, 2025
1:30 – 3:00 p.m., Pacific Time 

Agenda

Key Concepts in Medi-Cal Managed Care Financing

• What is Medicaid and how is it funded?
• Medi-Cal enrollment trends
• How the Medi-Cal program is paid for
• Gubernatorial and legislative impact on managed care financing
• Factors that influence the California budget process
• Sources of Medi-Cal funding

Introduction to Rate Setting

• How Medi-Cal managed care plans are paid
• Risk — how it relates to Medi-Cal managed care rate setting
• Federal and state rate-setting requirements

Session 2

The Rate Development Process & State Oversight of Plan Finances
March 24, 2025
1:30 – 3:00 p.m., Pacific Time 

Agenda

The Rate Development Process

• What data is used for rate setting
• Key components of the rate development process
• Factors that impact rate setting, plan revenue

State Oversight of 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

Faculty

Jennifer Lopez
Chief Financial Officer
Partnership HealthPlan of California

Jennifer Lopez is Partnership HealthPlan’s Chief Financial Officer and LHPC’s former Director of Health Plan Financing. She has a longstanding background in the public sector and the Medi-Cal program. During Jennifer’s time as Chief of the Capitated Rates Development Division at the California Department of Health Care Services, she acquired a deep knowledge base in Medi-Cal managed care financing and rate development. At the California Department of Finance, Jennifer played an instrumental role in major State Budget initiatives, developing public policy positions and advising administration officials on critical policy matters affecting millions of Californians.

Kyle Edrington
Principal (Actuarial)
Health Management Associates

Kyle Edrington founded Edrington Health Consulting where he was responsible for the design, development and communication of client engagements. He currently serves as a Principal with Health Management Associates.

Kyle provides a skillset unique to other actuarial consultants, leveraging experience as an analyst, consultant and lead strategist. He has significant experience working with contracted Medicaid managed care health plans and provides support to multiple states. Kyle helps health plans effectively understand how to plan for and react to their capitation rates, as well as how health plan dynamics may influence the rate development process.

Registration

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

Fees* (per connection)
Individual Session                   $50
Full Series                             $100
Plan Series Registration^     $200
^ Select this option if plan staff will view the webinars communally on-site. Plans with multiple sites must register each site separately and identify whom at each site should receive the webinar access information upon registering. When registering, please enter unique email addresses for each additional site as the system may not allow duplicate logins.​

Registration closes March 13 at 5:00 p.m.

Register for Session 1 only
Register for Session 2 only
Register for the Full Series

Registration Confirmation: Registrants will receive two emails — a registration confirmation email and a separate email that contains access information for the webinar. 

Participating in the Webinar: You will only need a computer with an updated web browser (Google Chrome, Microsoft Edge, Mozilla Firefox or Safari are recommended). Participants may opt to listen to the webinar via telephone or device. 

Cancellation 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 or participate in the event, and for which a cancellation notice is not received.