California Medi-Cal Care Crisis Sparks State Action
California Medi-Cal beneficiaries face severe disruptions as the state steps in to halt an abrupt care termination by insurance provider Health Net. The California Department of Health Care Services (DHCS) ordered Health Net to maintain assisted living and in-home care services through December 31, 2026, and to submit comprehensive transition plans for affected members, according to CalMatters. Failure to comply could result in daily penalties of $25,000 per member.
Regulatory Violations and Impact on Seniors
DHCS identified eight major regulatory violations during Health Net’s recent attempt to end services, including failing to submit individual transition plans, neglecting to secure proper alternative care, and improperly denying coverage. Advocacy groups estimate that roughly 3,500 Medi-Cal patients, predominantly low-income seniors and individuals with cognitive disorders like dementia, rely on Health Net for assisted living facility care costs. While board-and-care and memory care facilities cover 24-hour support, residents and their families were given short notice to find alternative housing.
Uncertainty Looms After December 31
Health Net operates Medi-Cal plans across 10 counties, including Los Angeles, Amador, Calaveras, Fresno, Inyo, Mono, Sacramento, San Joaquin, Stanislaus, and Tulare. Although the state directive forces the insurer to keep services running until the end of the year, Health Net’s plan to exit the program remains unchanged. Experts warn that transitioning to another Medi-Cal managed care plan does not guarantee continued assisted living coverage, leaving vulnerable seniors at risk of homelessness or placement in skilled nursing facilities.
