Like other health insurers, Westlake-based L.A. Care Health Plan underwent a number of challenges during the Covid-19 pandemic as it sought to address shifting needs among its members – more than 2 million of whom were enrolled in the state’s no- or low-cost Medi-Cal program at the time.
Founded in 1997 with a mission of serving MediCal beneficiaries in Los Angeles County, it’s now, with nearly 2.6 million members, the largest publicly operated health plan in the nation. Medi-Cal continues to be its largest line of business.
The other lines of business include L.A. Care Covered (ACA exchange – 184,488); D-SNP (Duals – Medicare/Medicaid – 19,600) and PASC-SEIU (In-home caregivers plan 48,949).
When the pandemic hit in 2020, large numbers of patients declined to see their primary physicians and postponed immunizations for their children. Hospitals also delayed elective surgeries.
The company saw a large influx of Medi-Cal members, going from just under 2 million in December 2019 to slightly more than 2.7 million in December 2022, as the federal government waived redetermination requirements for states enabling enrollees to keep their benefits. The redetermination process resumed last April, reducing the Medi-Cal numbers to slightly more than 2.3 million.
According to Chief Medical Officer Dr. Sameer Amin, the biggest challenge for L.A. Care right now is getting Medi-Cal members and others who may no longer have coverage, back into care, so they can resume screenings and immunizations and address any conditions they may have developed.
To expedite the process, the company has unveiled a number of quality of care campaigns via phone, text message and billboard.
“There is a hesitancy among some of our members to return to in-person care and to reconnect with longitudinal primary care,” said Amin.
L.A. Care is also one of two insurers to join hands with the Los Angeles County Office of Education and the L.A. County Department of Mental Health to provide access to virtual mental health services for the county’s K-12 public school students through a partnership with telehealth company Hazel Health.
All local education agencies in the county can opt in to participate in the program, which will allow students to speak with a provider while in school. L.A. Care and Health Net have allocated up to $24 million to cover the services over a two-year period.
“A large number of our initiatives go outside of the realm of what traditional health insurers provide,” said Amin. “We have tried to cast a wide safety net that extends to the unhoused.”
The insurer expects to spend $1.2 billion between 2022 and 2029 on programs to assist the unhoused in receiving appropriate health care, obtaining temporary and permanent housing and sustaining housing.
“We’ve gone to great length to make medical care available to this population through outreach efforts, community supports programs and enhanced care management,” said Amin. “We have also provided extensive services at 14 community resource centers, including courses on nutrition, social services and health and wellness classes.”
As the health plan tries to expand its reach, it has advocated with others in the health care ecosystem to increase provider and facility funding.
Rising labor costs and increased administrative burdens have affected the medical safety net’s ability to care for Medi-Cal members, said Amin.
“We have worked together as a community to improve reimbursements, helping our providers care for Medi-Cal members,” said Amin. “L.A. Care will continue to work with our partners in Medi-Cal to improve funding for the programs and network that support our members.”
