Assessing Cost-Effectiveness and Member Choice Across Medi-Cal Health Plan Models
Within California’s Medicaid program (Medi-Cal), counties with greater participation of private managed care plans (MCPs) show superior effectiveness in containing costs, preserving member choice, and fostering competition.
California’s Medi-Cal program operates at the county level, which each county selecting its own model for managed care. These include Two-Plan, Single Plan, County Organized Health System (COHS), Geographic Managed Care, and Regional models, each with varying levels of private health plan participation and member MCP choice.
The Elevance Health Public Policy Institute engaged The Menges Group to examine cost-effectiveness and competition across these models. Findings show that in 2025, private plans received approximately 30% lower capitation rates for adults and 20% lower rates for children compared with local plans in Two-Plan counties. The analysis also identifies higher average costs in models without private plan participation and fewer health plan choices for Medi-Cal members compared with other coverage programs.
Related Public Policy Research
Executing Payment Integrity Through Medicaid Managed Care
Medicaid managed care organizations are well positioned to successfully prevent and recover improper spending of Medicaid funds. This paper outlines how Elevance Health’s payment integrity framework uses front-end controls, provider engagement, advanced analytics, specialized investigations, and government collaboration to prevent and detect improper payments.
Healthcare Quality and Access for Children and Youth in Foster Care by Delivery System
Children and youth in foster care (CYFC) experience complex health needs. New research shows that CYFC enrolled in Medicaid managed care—especially plans tailored to CYFC—have significantly better preventive, behavioral health, and chronic care outcomes compared to fee-for-service.
Medicaid Managed Care Delivers Value and Efficiency to States
Findings from the literature demonstrate that, compared to FFS, Medicaid managed care improves quality and individuals’ experience, enhances access to care, and helps states manage costs.