L.A. Care Health Plan
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 official logo | |
| Agency overview | |
|---|---|
| Formed | April 1, 1997[1] |
| Type | Local public authority |
| Jurisdiction | Los Angeles County[1] |
| Headquarters | 1200 W. 7th Street Los Angeles, CA 90017 |
| Annual budget | US$8.77B (2015)[2] |
| Agency executives |
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| Website | lacare |
The Local Initiative Health Authority for Los Angeles County (L.A. Care) is a public agency that provides health insurance for low-income individuals in Los Angeles County through four health coverage programs including Medi-Cal.
Launched in 1997, in March 2022 LA Care was fined $55 million by the California Department of Managed Health Care and the California Department of Health Care Services for "deep-rooted, systemic failures that threaten the health and safety of its members." [3][4] In September 2023, the company agreed to a $1.3 million settlement to resolve two HIPAA violations.[5]
History and structure
L.A. Care Health Plan (Local Initiative Health Authority for Los Angeles County) was created by the State of California to provide health care services for Medi-Cal managed care beneficiaries, uninsured children and other vulnerable populations in Los Angeles County.[6]
In 1993, the State Department of Health Services produced a report entitled “Expanding Medi-Cal Managed Care: Reforming the Health System – Protecting Vulnerable Populations” which served as a blueprint for expansion of Medi-Cal managed care. It designated L.A. County as one of the areas for the “Two-Plan Model” where a locally organized Medi-Cal managed care plan (local initiative health plan) would be formed to compete directly for Medi-Cal managed care enrollments with a “commercial plan.” After a competitive selection process, Health Net of California was chosen by the State as the “commercial plan,” L.A. Care Health Plan was formed as the Local Initiative Health Authority of Los Angeles County, and the Two-Plan Model began to operate in L.A. County.[1]
During its 1997 launch, L.A. Care contracted with seven established health plans, referred to as plan partners: Blue Cross of California (now Anthem), Community Health Plan (CHP), Kaiser Permanente, Care 1st, UHP, Tower Health Plan and Maxicare. By 2006, L.A. Care had established its own direct line of business in Medi-Cal. L.A. Care partners include Kaiser Permanente.[6][7]
In 1998, L.A. Care became involved in the Healthy Families program, California's version of the Children's Health Insurance Plan (CHIP), and then in 2003 launched L.A. Care's Healthy Kids program for children ages 0–5, funded in partnership with First 5 LA and the Children's Health Initiative of Greater Los Angeles. Healthy Kids was established as an insurance program for families who do not qualify for Medi-Cal or Healthy Families due to either income or immigration status. It was expanded to children ages 6–18 in 2004. L.A. Care announced that the Healthy Kids programs would end at the end of 2016 as a result of SB 75 – a California law implemented in May 2016 – which expanded full-scope Medi-Cal benefits to all low-income children regardless of immigration status.
In 2008, L.A. Care launched the Medicare Advantage Special Needs Plan (SNP) for those dually-eligible for both Medi-Cal and Medicare. L.A. Care closed the Medicare SNP on December 31, 2014, as it chose to participate in the Cal MediConnect dual-eligible pilot. In January 2015, L.A. Care began accepting passive enrollment into the Cal MediConnect program. Cal MediConnect offers members a coordinated care model within a single health plan and will help to foster better health outcomes and improved quality of life for dual-eligibles.[8]
On October 1, 2013, L.A. Care Health Plan launched L.A. Care Covered, a health plan accredited by the NCQA and selected by Covered California to administer health insurance to Los Angeles County residents.
Governance
L.A. Care is governed by a 13-member stakeholder Board of Governors representing consumers, community clinics, physicians, hospitals, federally-qualified health centers, children's health care providers, and the Los Angeles County Department of Health Services. Two of the seats are held by consumers who are elected by L.A. Care enrollees. L.A. Care is among the few public health plans to have consumer members on its governing board with full voting privileges.[9]
Fifteen consumer advisory committees from across Los Angeles County advise the board of governors.[10]
Community grantmaking
L.A. Care launched its Community Health Investment Fund in 2001. Since then, it has awarded more than $132 million in grants and support for the health care safety net, to improve community and public health and expand health insurance coverage among underserved populations.[11] Grant initiatives include the Tranquada Awards,[12][13] which provide infrastructure support for safety net clinics, the Oral Health Initiative,[14] which expands access to dental care for low-income Angelenos, and the Health Information Technology Initiative,[15] which helps clinics purchase and implement technologies such as disease registries and electronic health records.
In 2017, L.A. Care announced a $20 million commitment to address homelessness in Los Angeles County. The five-year commitment is with Brilliant Corners, a nonprofit that works with the county's Housing for Health program.[16]
Community resource centers
Jointly operated by Blue Shield of California Promise Health Plan and L.A. Care Health Plan, community resource centers offer member support services, enrolment in local and state assistance programs and other community services. Centers are currently located in Pomona, Lynwood, East Los Angeles and Palmdale. The centers, to total 14, are part of a five-year, $146 million initiative launched by the two health plans in 2019 to expand community health access across Los Angeles County.[17]
L.A. Care Health Plan previously operated Family Resource Centers.[18] They were located in East L.A., Lynwood, Inglewood, Boyle Heights, Pacoima and Palmdale, CA, providing free health education, fitness and nutrition classes to all community members.[19][20][21]
Programs
Promotion of health information technology
In April 2010, L.A. Care was awarded a federal grant to establish a Health Information Technology Regional Extension Center (REC), called HITEC-LA, to help doctors in L.A. County adopt and use Electronic Health Records (EHRs).[22] HITEC-LA is the sole REC in L.A. County, under the terms of the grant. The grant was awarded by the U.S. Department of Health and Human Services through the Health Information Technology for Economic and Clinical Health Act (HITECH Act), of the American Recovery and Reinvestment Act of 2009.[23][24]
2018 initiative to address physician shortage
In July 2018, L.A. Care launched Elevating the Safety Net, a long-term initiative to recruit primary care physicians to the Los Angeles County safety net. The L.A. Care Board of Governors committed $31 million for the initiative, which has three programs: medical school scholarships, medical school loan repayments and a recruitment program to help clinics and practices with physician salary subsidies, sign-on bonuses and relocation costs.[25]
In 2021, L.A. Care provided $3.2 million to Charles Drew University of Medicine and Science, White Memorial Medical Center Charitable Foundation, AltaMed Health ServicesCorporation, and the David Geffen School of Medicine at UCLA in support of 25 residency positions.[26]
Legal actions and compliance issues
In March 2022 LA Care was fined $55 million by the California Department of Managed Health Care and the California Department of Health Care Services for "deep-rooted, systemic failures that threaten the health and safety of its members." [3] In March 2023, the Los Angeles Times reported that, according to hospitals in the region, the problems persisted and had reached a "crisis point."[27] LA Care agreed to pay $1.3 million to settle patient privacy violations in September 2023.[5]
See also
References
- ^ a b c MEDICAL REVIEW – SOUTHERN SECTION I AUDITS AND INVESTIGATIONS DEPARTMENT OF HEALTH CARE SERVICES https://www.dhcs.ca.gov/services/Documents/MMCD/2016LACareMedicalAuditReport.pdf
- ^ "FINANCIAL CONDITION REVIEW FOR FISCAL YEAR 2016-17" (PDF). L.A. Care Health Plan. 2018. Retrieved 3 May 2019.
- ^ a b Muoio, Dave (2022-03-07). "L.A. Care penalized $55M for 'deep-rooted, systemic failures' endangering vulnerable members". Fierce Healthcare. Retrieved 2022-12-08.
- ^ Dolan, Jack; Mejia, Britney (2022-03-04). "L.A. County health plan hit with huge fines for delays in treating poor patients". Los Angeles Times. Retrieved 2022-12-08.
- ^ a b Garcia, Karen (2023-09-11). "L.A. Care to pay $1.3 million to settle patient privacy violations". Los Angeles Times. Retrieved 2023-09-13.
- ^ a b "Medi-Cal Managed Care: An Overview and Key Issues". 2 March 2016. Retrieved 6 May 2019.
- ^ "Care1st Health Plan Announces Name Change to Blue Shield of California Promise Health Plan" (Press release). Blue Shield. April 3, 2018.
- ^ "Dual Eligibles Coordinated Care Demonstration - Cal MediConnect". Retrieved May 7, 2019.
- ^ "HMO Members Elect Own Representatives to Governing Board of L.A. Care Health Plan". Business Wire. 13 September 1999.
- ^ "LA Care Health Plan (aka Local Initiative Health Authority Governing Board)", Commissions: Membership Rosters (website), County of Los Angeles, archived from the original on July 26, 2011
- ^ 15 Years and One Million Members Strong: 15th Anniversary Report (Report). L.A. Care Health Plan. 1956.
- ^ "L.A. Care Awards $795,000 to Five Health Clinics for Infrastructure Improvement Projects" (Press release). L.A. Care Health Plan. May 12, 2010. Archived from the original on June 5, 2012. Retrieved September 18, 2012.
- ^ Ledue, Chelsey (May 20, 2010), "L.A. Care awards $795,000 to five health clinics for infrastructure improvements", Healthcare Finance News, New Gloucester, Maine: MedTech Media
- ^ "L.A. Care Awards $635,000 to Increase Free and Affordable Dental Services for the Underserved Residents of Los Angeles County" (Press release). L.A. Care Health Plan. September 7, 2011. Archived from the original on April 15, 2013. Retrieved September 18, 2012.
- ^ "L.A. Care Grants Over $500,000 to Support Meaningful Use of Health Information Technology" (Press release). L.A. Care Health Plan. August 10, 2010. Archived from the original on April 15, 2013. Retrieved September 18, 2012.
- ^ "Insurance provider wades into LA's homelessness problem". Southern California Public Radio. April 13, 2017. Retrieved May 6, 2019.
- ^ Mhealthintelligence (September 24, 2020), "LA Community Centers Offer Free Wi-Fi to Support Telehealth Services", mHealthIntelligence, xtelligent Healthcare Media
- ^ "Resource centers target costs through SDOH". State of Reform. April 8, 2019. Retrieved May 6, 2019.
- ^ Lewis, Jason (July 23, 2009), "Family Resource Center Opens in Inglewood", Los Angeles Sentinel
- ^ Staff (July 8, 2010), "L.A. Care to Celebrate Anniversary of Resource Center", LA Watts Times, The Pulse, Rancho Cucamonga, California: MediaStretch
- ^ "L.A. Care Celebrates the 1st Anniversary of its Inglewood Family Resource Center", Los Angeles Wave, Los Angeles, California: Los Angeles Wave Publications Group, July 17, 2010[dead link]
- ^ Ledue, Chelsey (July 28, 2010), "Grant Will Connect Los Angeles County Clinics to HIE", Healthcare IT News, New Gloucester, Maine: MedTech Media
- ^ Ledue, Chelsey (April 9, 2010), "L.A. Care Health Plan receives $15.6M grant to advance use of health IT", Healthcare Finance News, New Gloucester, Maine: MedTech Media
- ^ REC Program (website), Office of the National Coordinator for Health Information Technology HITECH Extension Program (published December 9, 2011), 2011, archived from the original on July 21, 2011
- ^ "L.A. CARE LAUNCHES $31M PHYSICIAN RECRUITING INITIATIVE". H3.Group. July 16, 2018. Retrieved May 7, 2019.
- ^ "Residency grant given to Charles Drew University". OurWeekly Los Angeles. November 23, 2021. Retrieved December 14, 2021.
- ^ Reyes-Alpert, Emily (2023-03-26). "Hospitals complain problems persist a year after L.A. Care was hit with record fines". Los Angeles Times. Retrieved 2023-09-13.