L.A. Care Health Plan

L.A. Care Health Plan

L.A. Care Health Plan is an independent, local public agency based in Los Angeles, California, that began operations as a licensed health plan in 1997. The organization serves low-income people in Los Angeles County through four health coverage programs including Medi-Cal, Healthy Families Program, L.A. Care’s Healthy Kids, and L.A. Care’s Medicare Advantage Special Needs Plan.

L.A. Care is the nation’s largest public health planAIS Health Market Share Data, with more than 800,000 enrolled members, and has been awarded an Excellent Accreditation by the National Committee for Quality Assurance.National Committee for Quality Assurance Search EngineNCQA Online Report Card

Company Description

L.A. Care Health Plan (Local Initiative Health Authority of 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.California State Council on Developmental Disabilities Online Library

It is also a tax-exempt public entity, subject to state rules and regulations governing public entities. This means that L.A. Care is subject to California’s Brown Act, mandating that all Board decision-making must take place at public meetings.

Coverage Programs

• Medi-Cal. Medi-Cal is California’s version of Medicaid and is the only public program that covers some low-income adults (like pregnant women, seniors, and persons with disabilities) as well as children. In addition to offering a direct Medi-Cal line of business, L.A. Care contracts with four Plan Partners to provide coverage to Medi-Cal members. These Partners are Anthem Blue Cross, Care 1st Health Plan, Community Health Plan, and Kaiser Permanente.
• Healthy Families Program. Healthy Families, California State Children's Health Insurance Program (CHIP), provides health coverage to children who do not qualify for Medi-Cal but whose families cannot afford private health insurance.
• L.A. Care’s Healthy Kids. Sponsored by First 5 LA and the Children’s Health Initiative of Greater Los Angeles, Healthy Kids provides health coverage for children who do not qualify for Medi-Cal or Healthy Families, up to 300% of the Federal Poverty Level.
• L.A. Care Health Plan Medicare Advantage HMO SNP. The L.A. Care Medicare Advantage HMO SNP provides coordinated care for Los Angeles County seniors and people with disabilities who are eligible for Medicare and Medi-Cal.

History and Structure

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.” In 1997, L.A. Care Health Plan was formed as the Local Initiative Health Authority of Los Angeles County, and enrolled its first Medi-Cal members. After a competitive selection process, Health Net of California was chosen by the State as the “commercial plan,” and the Two-Plan Model began to operate in Los Angeles County.California State Council on Developmental Disabilities Online Library

During its 1997 launch, L.A. Care contracted with seven established health plans, referred to as plan partners: Blue Cross of California (now Anthem Blue Cross), 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.California Department of Health Services Directory

L.A. Care has also been involved in the Healthy Families program, California’s version of the Children’s Health Insurance Plan (CHIP), since 1998, and 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 reach children ages 6-18 in 2004.Children's Health Initiative of Greater Los Angeles Healthy Kids info downloadable pdf file

In 2008, L.A. Care launched the Medicare Advantage Special Needs Plan (SNP) for those dually-eligible for both Medi-Cal and Medicare.

Governance

L.A. Care is governed by a 13-member stakeholder board, of which two are elected by L.A. Care members. Representatives include consumer members, community clinics, physicians, federally-qualified health centers, children’s health care providers, hospitals, Los Angeles County and its Department of Health Services.

Several committees advise the board of governors, including a health care professionals committee, a children’s health committee and an executive community advisory committee representing eleven regional advisory committees.LA County Board of Supervisors Commission Membership Roster Directory

Community Grant-making

L.A. Care launched its Community Health Investment Program in 2001. Since then, it has awarded more than $100 million in grants and support for the regional safety net, to improve community and public health and expand health insurance coverage among underserved populations. Grant initiatives include the Tranquada Awards, which provide infrastructure support for safety-net clinics, the Oral Health Initiative, which expands access to dental care for low-income Angelenos, and the Health Information Technology Initiative, which helps clinics purchase and implement technologies such as disease registries and electronic health records.

Family Resource Centers

L.A. Care Health Plan has two Family Resource Centers, one in Lynwood, CA, and one in Inglewood, CA. These centers provide free health education, fitness and nutrition classes to all community members.

Promotion of Electronic Health Records

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). 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. Office of the National Coordinator for Health Information Technology HITECH Extension Program

External links

• L.A. Care Website