Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing federal Medicaid law requires the state to publish an online directory of physicians and, at state option, other providers, as specified. Existing state law sets forth Medi-Cal managed care provisions relating to a Medi-Cal applicant or beneficiary being informed of the health care options available regarding methods of receiving Medi-Cal benefits, including through certain provider directories. The department has administratively created an online provider directory through an internet website known as Medi-Cal Managed Care Health Care Options.

This bill would require, as part of the health care options information posted by the department, in the provider directory that lists accepted Medi-Cal managed care plans, through the Medi-Cal Managed Care Health Care Options internet website and any other applicable mechanisms, that the directory include skilled nursing facilities as one of the available searchable provider types. The bill would require that this provision be implemented in conjunction with implementation of the above-described provisions. The bill would require the department to annually update that provider directory to ensure that information is accurate and readily accessible to the public.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing federal Medicaid law requires the state to publish an online directory of physicians and, at state option, other providers, as specified. Existing state law sets forth Medi-Cal managed care provisions relating to a Medi-Cal applicant or beneficiary being informed of the health care options available regarding methods of receiving Medi-Cal benefits, including through certain provider directories. The department has administratively created an online provider directory through an internet website known as Medi-Cal Managed Care Health Care Options.

This bill would require, as part of the health care options information posted by the department, in the provider directory that lists accepted Medi-Cal managed care plans, through the Medi-Cal Managed Care Health Care Options internet website and any other applicable mechanisms, that the directory include skilled nursing facilities as one of the available searchable provider types. The bill would require that this provision be implemented in conjunction with implementation of the above-described provisions. The bill would require the department to annually update that provider directory to ensure that information is accurate and readily accessible to the public.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing federal Medicaid law requires the state to publish an online directory of physicians and, at state option, other providers, as specified. Existing state law sets forth Medi-Cal managed care provisions relating to a Medi-Cal applicant or beneficiary being informed of the health care options available regarding methods of receiving Medi-Cal benefits, including through certain provider directories. The department has administratively created an online provider directory through an internet website known as Medi-Cal Managed Care Health Care Options.

This bill would require, as part of the health care options information posted by the department, in the provider directory that lists accepted Medi-Cal managed care plans, through the Medi-Cal Managed Care Health Care Options internet website and any other applicable mechanisms, that the directory include skilled nursing facilities as one of the available searchable provider types. The bill would require that this provision be implemented in conjunction with implementation of the above-described provisions. The bill would require the department to annually update that provider directory to ensure that information is accurate and readily accessible to the public.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing federal Medicaid law requires the state to publish an online directory of physicians and, at state option, other providers, as specified. Existing state law sets forth Medi-Cal managed care provisions relating to a Medi-Cal applicant or beneficiary being informed of the health care options available regarding methods of receiving Medi-Cal benefits, including through certain provider directories. The department has administratively created an online provider directory through an internet website known as Medi-Cal Managed Care Health Care Options.

This bill would require, as part of the health care options information posted by the department, in the provider directory that lists accepted Medi-Cal managed care plans, through the Medi-Cal Managed Care Health Care Options internet website and any other applicable mechanisms, that the directory include skilled nursing facilities as one of the available searchable provider types. The bill would require that this provision be implemented in conjunction with implementation of the above-described provisions.

 UNFINISHED BUSINESS  

Bill No: SB 250

Author: Ochoa Bogh (R)

Amended: 6/17/25 in Assembly

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 3/26/25

AYES: Menjivar, Valladares, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Weber Pierson, Wiener

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/23/25

AYES: Caballero, Seyarto, Cabaldon, Grayson, Richardson, Wahab

NO VOTE RECORDED: Dahle

SENATE FLOOR: 38-0, 5/29/25

AYES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

NO VOTE RECORDED: Limón, Reyes

ASSEMBLY FLOOR: 77-0, 9/4/25 - See last page for vote

SUBJECT: Medi-Cal: provider directory: skilled nursing facilities

SOURCE: California Advocates for Nursing Home Reform

DIGEST:

This bill requires the Department of Health Care Services to include skilled nursing facilities as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection directory website.

Assembly Amendments

of 6/17/25 require the Department of Health Care Services (DHCS) to annually update the directory above to ensure that information is accurate and readily accessible to the public.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. (Welfare and Institutions Code (WIC) §14000, et seq.)
2. Authorizes the DHCS Director to contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal beneficiaries and establishes managed care models that DHCS contracts with in each county. (WIC §14087.3, §14089, §14087.98, §14087.967, and §14087.5)
3. Defines a Medi-Cal managed care plan (Medi-Cal plan) as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. (WIC §14184.101)
4. Defines a skilled nursing facility (SNF) as a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. (Health and Safety Code (HSC) §1250)
5. Requires Medi-Cal plans to cover SNF services for Medi-Cal recipients as part of its contracts with DHCS. (WIC §14184.201)
6. Requires health plans, including Medi-Cal plans, to publish and maintain a provider directory with information on contracting providers that deliver health care services to the plan’s enrollees, including those that accept new patients and prohibits listing or including information on a provider that is not currently under contract. Specifies SNFs as included providers. (HSC §1367.27)
7. Allows Medi-Cal recipients in counties with more than one Medi-Cal plan to enroll in any Medi-Cal plan covering the geographic area in which they reside.

(WIC §14016.5, §14087.305, and §14089)

This bill requires DHCS to include SNFs as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection directory website and annually update the directory to ensure that information is accurate and readily accessible to the public.

Comments

According to the author of this bill:

Navigating long-term care options can feel overwhelming, particularly for individuals who require 24/7 skilled nursing. As of November 2024, there are almost 1,200 SNFs across California, but there is no single public source for recipients looking to choose a facility that accepts a specific Medi-Cal plan or choose a Medi-Cal plan that covers a specific facility. By ensuring that the facility information DHCS already collects is publically displayed, this bill will ease barriers to accessing information for older adults and people with disabilities in their (or their caregivers) search for a facility or plan that best fits their needs.

Background

Medi-Cal Managed Care Models and Health Care Options Process. In California, the plans that are available to a Medi-Cal recipient is dependent on which county the recipient lives in: 37 counties are organized either through a single County-Organized Health System or have just one plan; 21 counties have two or more choices for recipients to choose from. When an individual applies for and qualifies for Medi-Cal, they are initially covered under Medi-Cal fee-for-service. Individuals in single-plan counties are then directly enrolled into the only Medi-Cal plan. Individuals in a multi-plan county must choose and enroll in a Medi-Cal plan within 30 days. Medi-Cal recipients that do not choose a plan within 30 days are automatically assigned to a plan by DHCS. Recipients in the 21 multi-plan counties receive information on their plan choices through the Health Care Options process, which is administered by a vendor (Maximus) that contracts with DHCS. Health Care Options sends recipients a welcome packet with information and maintains a website with plan enrollment information, including an online provider directory that allows recipients to see which plans cover which providers in their area. The online provider directory currently allows searches by the following provider types: doctor, hospital, medical clinic, dental clinic, or dentist. In addition, Kaiser plans are an option in some of the single or multi-plan counties, but enrollment in Kaiser is limited to those with a previous Kaiser enrollment, other Kaiser-enrolled family members, or who are automatically assigned to Kaiser after failing to choose a plan. Kaiser providers are not part of the Health Care Options website as this was not included in the statute authorizing DHCS to contract with them.

Inclusion of SNF services in Medi-Cal plan contracts. The Medi-Cal program provides benefits through both a fee-for-service and managed care delivery system. In Medi-Cal fee-for-service, an individual may go to any provider that contracts with DHCS; in the managed care delivery system, an individual is limited to the providers that contract with the Medi-Cal plan, subject to certain exceptions. According to a 2024 DHCS All-Plan letter, prior to the California Advancing and Innovating Medi-Cal (CalAIM) initiative, Medi-Cal managed care services varied considerably among counties depending on the managed care plan model. CalAIM sought to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through benefit standardization. Prior to the implementation of CalAIM, coverage for SNF services varied. Prior to January 1, 2023, Medi-Cal plans operating in 27 counties covered SNF services under the institutional long-term care services benefit. In the other 31 counties, Medi-Cal plan enrollees who were in a SNF longer than one month were disenrolled from managed care and transferred to fee-for-service. Now, Medi-Cal plans in all counties must authorize and cover medically necessary SNF services. Recipients enrolled in a Medi-Cal plan will no longer be disenrolled from the plan when they need SNF services.

Related/Prior Legislation

AB 280 (Aguiar-Curry) of the current legislative session requires a health plan or insurer to annually verify and delete inaccurate listings from its provider directories; imposes administrative penalties for inaccurate provider directory listings; and, requires out-of-network services to be covered as in-network in specified circumstances due to inaccurate provider directory listings. AB 280 is pending on the Senate Floor.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Assembly Appropriations Committee the fiscal effect of this bill is no costs to DHCS. DHCS anticipates the mandated changes to the Health Care Options directory will be absorbable within the existing contract and staff workload.

SUPPORT: (Verified 9/4/2025)

California Advocates for Nursing Home Reform (source)

AARP California

Alzheimer’s Association

California Long-Term Care Ombudsman Association

California Senior Legislature

County of Los Angeles

Flagstone Health

Greater Coachella Valley Chamber of Commerce

Western Center on Law & Poverty

OPPOSITION: (Verified 9/4/2025)

None received

ARGUMENTS IN SUPPORT: Sponsors California Advocates for Nursing Home Reform write that Medi-Cal plans cover more than six in 10 nursing home residents in California, but each plan contracts with only a limited number of nursing homes. This means that Medi-Cal recipients must either contact the plan or call individual facilities to find out who contracts with their Medi-Cal plan. They state that they get thousands of calls from across California from individuals needing help to navigate the long-term care system. This will simply require public display of facility information that DHCS already collects. AARP California states that by 2030, one quarter of Californians will be 60 or older, and navigating complex programs and directories is already a challenge for many Californians. This bill would reduce obstacles to accessing information for older adults and individuals with disabilities who are searching for a facility or plan that best fits their needs.

ASSEMBLY FLOOR: 77-0, 9/4/25

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Elhawary, Ellis, Flora, Fong, Gabriel, Gallagher, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Jackson, Kalra, Krell, Lackey, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Tangipa, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NO VOTE RECORDED: Ahrens, Lee

Prepared by: Jen Flory / HEALTH / (916) 651-4111

9/6/25 10:40:13

**** END ****

Date of Hearing: June 24, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

SBPCA Bill Id:SB 250

Author:(Ochoa Bogh) – As Amended Ver:June 17, 2025

SENATE VOTE: 38-0

SUBJECT: Medi-Cal: provider directory: skilled nursing facilities.

SUMMARY: Requires the Department of Health Care Services (DHCS), for purposes of the Medi-Cal program, to provide a public provider directory that lists which skilled nursing facilities (SNFs) are contracted with each Medi-Cal managed care plan as part of a specific “Health Care Options” website administered by DHCS. Requires DHCS to update the provider directory annually.

EXISTING LAW:

1. Establishes the Medi-Cal program, which is administered by DHCS, under which qualified low-income individuals receive health care services. [Welfare and Institutions Code (WIC) § 14000, et seq.]
2. Authorizes the DHCS Director to contract, on a bid or non-bid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal beneficiaries and establishes managed care models that DHCS contracts with in each county. [WIC §§ 14087.3, 14089, 14087.98, 14087.967, and 14087.5]
3. Defines a Medi-Cal managed care plan as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. [WIC § 14184.101]
4. Defines a SNF as a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. [Health and Safety Code (HSC) § 1250]
5. Establishes the California Advancing and Innovating Medi-Cal (CalAIM) Act, and requires the implementation of CalAIM to support a number of goals, including transforming the Medi-Cal program to a more consistent and seamless system by reducing complexity. [WIC § 14184.100]
6. Makes nursing facility services a covered Medi-Cal benefit and requires, under CalAIM, DHCS to standardize Medi-Cal covered benefits provided through Medi-Cal managed care plans. Requires plans to cover SNF services for Medi-Cal recipients as part of its contracts with DHCS. [WIC §§ 14132 (c), 14184.201]
7. Requires health plans, including Medi-Cal managed care plans, to publish and maintain a provider directory with information on contracting providers that deliver health care services to the plan’s enrollees, including those that accept new patients and prohibits listing or including information on a provider that is not currently under contract. Specifies SNFs as included providers. [HSC § 1367.27]
8. Allows Medi-Cal recipients in counties with more than one Medi-Cal managed care plan to enroll in any plan covering the geographic area in which they reside. [WIC §§ 14016.5, 14087.305, and 14089]

FISCAL EFFECT: According to the Senate Appropriations Committee, unknown, one-time and/or ongoing costs for state staffing and/or vendor costs to update and maintain the Managed Care Health Care Options plan selection website (General Fund and federal funds).

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, navigating long-term care options can feel overwhelming, particularly for individuals who require 24/7 skilled nursing. The author notes that, as of November 2024, there are almost 1,200 SNFs across California, but there is no single public source for recipients looking to choose a facility that accepts a specific Medi-Cal plan or choose a Medi-Cal plan that covers a specific facility. By ensuring that the facility information DHCS already collects is publically displayed, the author argues, this bill will ease barriers to accessing information for older adults and people with disabilities when they search for a facility or plan that best fits their needs.
2. BACKGROUND.
   1. Medi-Cal Managed Care. California’s Medi-Cal benefits and services are largely delivered through Medi-Cal managed care plans. Each county in California has a certain set of Medi-Cal managed care plans that serve that county. Some counties only have a single plan that serves all Medi-Cal enrollees, but many counties have multiple plan options.
   2. Inclusion of SNF Services in Medi-Cal Managed Care Plan Contracts. Medi-Cal managed care plans must deliver a comprehensive set of benefits delineated in contracts with DHCS. Beginning in 2022, a Medi-Cal program improvement initiative called the CalAIM initiative sought to, among other things, streamline the delivery of Medi-Cal covered benefits by making benefits and services consistent across counties and plan models. Prior to the implementation of CalAIM, some plans covered SNF services; in certain counties, SNF services were provided through the fee-for-service (FFS) delivery system administered directly by DHCS. Starting January 1, 2023, SNF services were “carved in” to Medi-Cal managed care plan contracts statewide and all Medi-Cal managed care plans have thereby been required to cover medically necessary SNF services. Unlike in the FFS system, where an individual can seek services from any Medi-Cal enrolled provider, an individual in the Medi-Cal managed care delivery system is generally limited to the providers that contract with their plan.
   3. Health Care Options Process. A vendor under contract with DHCS, Maximus, administers the ‘Health Care Options” process, which supports Medi-Cal enrollees to understand their options and choose a plan. Health Care Options sends recipients a welcome packet with information and maintains a website with plan enrollment information, including an online provider directory. The directory allows recipients to see which plans cover which providers in their area, with the exception of Kaiser providers. The online provider directory currently allows searches by the following provider types: doctor, hospital, medical clinic, dental clinic, or dentist. The Health Care Options website also provides links to plan websites; these plan websites also host provider directories specific to each plan.

This bill is intended to provide information about which SNFs are contracted with which plans, to help individuals choose a plan that includes specific SNF providers.

1. SUPPORT. California Advocates for Nursing Home Reform (CANHR), sponsor of this bill, notes that Medi-Cal managed care plans cover more than 6 in 10 nursing home residents in California, but each plan contracts with only a limited number of nursing homes. This means that Medi-Cal recipients must either contact the plan or call individual facilities to find out who contracts with their Medi-Cal plan. CANHR states that they get thousands of calls from individuals across California who need help to navigate the long-term care system. According to the sponsor, this bill will simply require public display of facility information that DHCS already collects. AARP California states in support that by 2030, one quarter of Californians will be age 60 or older, and navigating complex programs and directories is already a challenge for many Californians. AARP writes that this bill would reduce obstacles to accessing critical information.
2. RELATED LEGISLATION. AB 280 (Aguiar-Curry), pending in the Senate Health Committee, would require a health care service plan (health plan) or health insurer to be responsible for maintaining an accurate provider directory and annually verify and delete inaccurate listings from its provider directories. It would also require a provider directory to be 60% accurate on July 1, 2026, with increasing accuracy benchmarks to be met each year until the directories are 95% accurate on or before July 1, 2029. It would also impose administrative penalties (fines) on health plans and insurers that fail to meet the benchmark rates. Lastly, AB 280 would exempt Medi-Cal managed care plans from the accuracy benchmarks and administrative penalty provisions.
3. PREVIOUS LEGISLATION. AB 236 (Holden) of 2024 was substantively similar to AB 280 and was held on suspense in the Senate Appropriations Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

California Advocates for Nursing Home Reform (sponsor)

AARP

Alzheimer's Association

California Long Term Care Ombudsman Association

California Senior Legislature

Flagstone Healthcare

The Greater Coachella Valley Chamber of Commerce

Western Center on Law & Poverty, Inc.

Opposition

None on file

Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 250

Author: Ochoa Bogh (R)

Introduced: 1/30/25

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 3/26/25

AYES: Menjivar, Valladares, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Weber Pierson, Wiener

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/23/25

AYES: Caballero, Seyarto, Cabaldon, Grayson, Richardson, Wahab

NO VOTE RECORDED: Dahle

SUBJECT: Medi-Cal: provider directory: skilled nursing facilities

SOURCE: California Advocates for Nursing Home Reform

DIGEST:

This bill requires the Department of Health Care Services to include skilled nursing facilities as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection website.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. (Welfare and Institutions Code (WIC) §14000, et seq.)
2. Authorizes the DHCS Director to contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal beneficiaries and establishes managed care models that DHCS contracts with in each county. (WIC §14087.3, §14089, §14087.98, §14087.967, and §14087.5)
3. Defines a Medi-Cal managed care plan (Medi-Cal plan) as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. (WIC §14184.101)
4. Defines a skilled nursing facility (SNF) as a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. (Health and Safety Code (HSC) §1250)
5. Requires Medi-Cal plans to cover SNF services for Medi-Cal recipients as part of its contracts with DHCS. (WIC §14184.201)
6. Requires health plans, including Medi-Cal plans, to publish and maintain a provider directory with information on contracting providers that deliver health care services to the plan’s enrollees, including those that accept new patients and prohibits listing or including information on a provider that is not currently under contract. Specifies SNFs as included providers. (HSC §1367.27)
7. Allows Medi-Cal recipients in counties with more than one Medi-Cal plan to enroll in any Medi-Cal plan covering the geographic area in which they reside.

(WIC §14016.5, §14087.305, and §14089)

This bill requires DHCS to include SNFs as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection website.

Comments

According to the author of this bill:

Navigating long-term care options can feel overwhelming, particularly for individuals who require 24/7 skilled nursing. As of November 2024, there are almost 1,200 SNFs across California, but there is no single public source for recipients looking to choose a facility that accepts a specific Medi-Cal plan or choose a Medi-Cal plan that covers a specific facility. By ensuring that the facility information DHCS already collects is publically displayed, this bill will ease barriers to accessing information for older adults and people with disabilities in their (or their caregivers) search for a facility or plan that best fits their needs.

Background

Medi-Cal Managed Care Models and Health Care Options Process. In California, the plans that are available to a Medi-Cal recipient is dependent on which county the recipient lives in: 37 counties are organized either through a single County-Organized Health System or have just one plan; 21 counties have two or more choices for recipients to choose from. When an individual applies for and qualifies for Medi-Cal, they are initially covered under Medi-Cal fee-for-service. Individuals in single-plan counties are then directly enrolled into the only Medi-Cal plan. Individuals in a multi-plan county must choose and enroll in a Medi-Cal plan within 30 days. Medi-Cal recipients that do not choose a plan within 30 days are automatically assigned to a plan by DHCS. Recipients in the 21 multi-plan counties receive information on their plan choices through the Health Care Options process, which is administered by a vendor (Maximus) that contracts with DHCS. Health Care Options sends recipients a welcome packet with information and maintains a website with plan enrollment information, including an online provider directory that allows recipients to see which plans cover which providers in their area. The online provider directory currently allows searches by the following provider types: doctor, hospital, medical clinic, dental clinic, or dentist. In addition, Kaiser plans are an option in some of the single or multi-plan counties, but enrollment in Kaiser is limited to those with a previous Kaiser enrollment, other Kaiser-enrolled family members, or who are automatically assigned to Kaiser after failing to choose a plan. Kaiser providers are not part of the Health Care Options website as this was not included in the statute authorizing DHCS to contract with them.

Inclusion of SNF services in Medi-Cal plan contracts. The Medi-Cal program provides benefits through both a fee-for-service and managed care delivery system. In Medi-Cal fee-for-service, an individual may go to any provider that contracts with DHCS; in the managed care delivery system, an individual is limited to the providers that contract with the Medi-Cal plan, subject to certain exceptions. According to a 2024 DHCS All-Plan letter, prior to the California Advancing and Innovating Medi-Cal (CalAIM) initiative, Medi-Cal managed care services varied considerably among counties depending on the managed care plan model. CalAIM sought to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through benefit standardization. Prior to the implementation of CalAIM, coverage for SNF services varied. Prior to January 1, 2023, Medi-Cal plans operating in 27 counties covered SNF services under the institutional long-term care services benefit. In the other 31 counties, Medi-Cal plan enrollees who were in a SNF longer than one month were disenrolled from managed care and transferred to fee-for-service. Now, Medi-Cal plans in all counties must authorize and cover medically necessary SNF services. Recipients enrolled in a Medi-Cal plan will no longer be disenrolled from the plan when they need SNF services.

Related/Prior Legislation

AB 280 (Aguiar-Curry) of the current legislative session requires a health plan or insurer to annually verify and delete inaccurate listings from its provider directories; imposes administrative penalties for inaccurate provider directory listings; and, requires out-of-network services to be covered as in-network in specified circumstances due to inaccurate provider directory listings. AB 280 is pending on the Senate Appropriations Committee suspense file.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, this bill would have unknown, one-time and/or ongoing costs for state staffing and/or vendor costs to update and maintain the Managed Care Health Care Options plan selection website (General Fund and federal funds).

SUPPORT: (Verified 5/23/25)

California Advocates for Nursing Home Reform (source)

AARP California

Alzheimer’s Association

California Long-Term Care Ombudsman Association

California Senior Legislature

Greater Coachella Valley Chamber of Commerce

OPPOSITION: (Verified 5/23/25)

None received

ARGUMENTS IN SUPPORT: Sponsors California Advocates for Nursing Home Reform write that Medi-Cal plans cover more than six in 10 nursing home residents in California, but each plan contracts with only a limited number of nursing homes. This means that Medi-Cal recipients must either contact the plan or call individual facilities to find out who contracts with their Medi-Cal plan. They state that they get thousands of calls from across California from individuals needing help to navigate the long-term care system. This will simply require public display of facility information that DHCS already collects. AARP California states that by 2030, one quarter of Californians will be 60 or older, and navigating complex programs and directories is already a challenge for many Californians. This bill would reduce obstacles to accessing information for older adults and individuals with disabilities who are searching for a facility or plan that best fits their needs.

Prepared by: Jen Flory / HEALTH / (916) 651-4111

5/26/25 15:41:02

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

SB 250 (Ochoa Bogh) - Medi-Cal: provider directory: skilled nursing facilities

Bill Summary:

SB 250 would require the Department of Health Care Services (DHCS) to include skilled nursing facilities (SNFs) as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection website.

Fiscal Impact:

Unknown, one-time and/or ongoing costs for state staffing and/or vendor costs to update and maintain the Managed Care Health Care Options plan selection website (General Fund and federal funds).

Background:

DHCS administers the Medi-Cal program, which provides health care services to low-income individuals. The Medi-Cal program provides benefits through both a fee-for-service and managed care delivery system. In Medi-Cal fee-for-service, an individual may go to any provider that contracts with DHCS; in the managed care delivery system, an individual is limited to the providers that contract with the Medi-Cal plan, subject to certain exceptions. Medi-Cal plans in all counties must authorize and cover medically necessary SNF services.

In California, the plans that are available to a Medi-Cal recipient depend on which county the recipient lives in. Thirty-seven counties are organized either through a single County-Organized Health System or have just one plan and twenty-one counties have two or more choices for recipients to choose from. When an individual applies for and qualifies for Medi-Cal, they are initially covered under Medi-Cal fee-for-service. Individuals in single-plan counties are then directly enrolled into the only Medi-Cal plan. Individuals in a multi-plan county must choose and enroll in a Medi-Cal plan within 30 days. Medi-Cal recipients that do not choose a plan within 30 days are automatically assigned to a plan by DHCS. In addition, Kaiser plans are an option in some of the single or multi-plan counties, but enrollment in Kaiser is limited to those with a previous Kaiser enrollment, other Kaiser-enrolled family members, or who are automatically assigned to Kaiser after failing to choose a plan.

Current law requires Medi-Cal plans to publish and maintain a provider directory with information on contracting providers that deliver health care services to the plan’s enrollees, including those that accept new patients, and prohibits listing or including information on a provider that is not currently under contract. The provider directory includes SNFs.

Medi-Cal recipients in the twenty-one multi-plan counties receive information on their plan choices through the Health Care Options process, which is administered by a vendor (Maximus) that contracts with DHCS. Health Care Options sends recipients a welcome packet with information and maintains a website with plan enrollment information, including an online provider directory that allows recipients to see which plans cover which providers in their area. The Health Care Options online provider directory currently allows searches by the following provider types: doctor, hospital, medical clinic, dental clinic, or dentist. Kaiser providers are not part of the Health Care Options website.

Proposed Law:

SB 250 would require DHCS to include SNFs as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection website.

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SENATE COMMITTEE ON HEALTH

Senator Caroline Menjivar, Chair

BILL NO: SB 250

SUBJECT: Medi-Cal: provider directory: skilled nursing facilities

SUMMARY:

Requires the Department of Health Care Services to include skilled nursing facilities as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection website.

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. [WIC §14000, et seq.]
2. Authorizes the DHCS Director to contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal beneficiaries and establishes managed care models that DHCS contracts with in each county. [WIC §14087.3, §14089, §14087.98, §14087.967, and §14087.5]
3. Defines a Medi-Cal managed care plan (Medi-Cal plan) as any individual, organization, or entity that enters into a comprehensive risk contract with DHCS to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries. [WIC §14184.101]
4. Defines a skilled nursing facility (SNF) as a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. [HSC §1250]
5. Requires Medi-Cal plans to cover SNF services for Medi-Cal recipients as part of its contracts with DHCS. [WIC §14184.201]
6. Requires health plans, including Medi-Cal plans, to publish and maintain a provider directory with information on contracting providers that deliver health care services to the plan’s enrollees, including those that accept new patients and prohibits listing or including information on a provider that is not currently under contract. Specifies SNFs as included providers. [HSC §1367.27]
7. Allows Medi-Cal recipients in counties with more than one Medi-Cal plan to enroll in any Medi-Cal plan covering the geographic area in which they reside.

[WIC §14016.5, §14087.305, and §14089]

This bill: Requires DHCS to include SNFs as a searchable provider type in its Medi-Cal Managed Care Health Care Options plan selection website.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, navigating long-term care options can feel overwhelming, particularly for individuals who require 24/7 skilled nursing. As of November 2024, there are almost 1,200 SNFs across California, but there is no single public source for recipients looking to choose a facility that accepts a specific Medi-Cal plan or choose a Medi-Cal plan that covers a specific facility. By ensuring that the facility information DHCS already collects is publically displayed, this bill will ease barriers to accessing information for older adults and people with disabilities in their (or their caregivers) search for a facility or plan that best fits their needs.
2. Medi-Cal Managed Care Models and Health Care Options Process. In California, the plans that are available to a Medi-Cal recipient is dependent on which county the recipient lives in: 37 counties are organized either through a single County-Organized Health System or have just one plan; 21 counties have two or more choices for recipients to choose from. When an individual applies for and qualifies for Medi-Cal, they are initially covered under Medi-Cal fee-for-service. Individuals in single-plan counties are then directly enrolled into the only Medi-Cal plan. Individuals in a multi-plan county must choose and enroll in a Medi-Cal plan within 30 days. Medi-Cal recipients that do not choose a plan within 30 days are automatically assigned to a plan by DHCS. Recipients in the 21 multi-plan counties receive information on their plan choices through the Health Care Options process, which is administered by a vendor (Maximus) that contracts with DHCS. Health Care Options sends recipients a welcome packet with information and maintains a website with plan enrollment information, including an online provider directory that allows recipients to see which plans cover which providers in their area. The online provider directory currently allows searches by the following provider types: doctor, hospital, medical clinic, dental clinic, or dentist. In addition, Kaiser plans are an option in some of the single or multi-plan counties, but enrollment in Kaiser is limited to those with a previous Kaiser enrollment, other Kaiser-enrolled family members, or who are automatically assigned to Kaiser after failing to choose a plan. Kaiser providers are not part of the Health Care Options website as this was not included in the statute authorizing DHCS to contract with them.
3. Inclusion of SNF services in Medi-Cal plan contracts. The Medi-Cal program provides benefits through both a fee-for-service and managed care delivery system. In Medi-Cal fee-for-service, an individual may go to any provider that contracts with DHCS; in the managed care delivery system, an individual is limited to the providers that contract with the Medi-Cal plan, subject to certain exceptions. According to a 2024 DHCS All-Plan letter, prior to the California Advancing and Innovating Medi-Cal (CalAIM) initiative, Medi-Cal managed care services varied considerably among counties depending on the managed care plan model. CalAIM sought to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through benefit standardization. Prior to the implementation of CalAIM, coverage for SNF services varied. Prior to January 1, 2023, Medi-Cal plans operating in 27 counties covered SNF services under the institutional long-term care services benefit. In the other 31 counties, Medi-Cal plan enrollees who were in a SNF longer than one month were disenrolled from managed care and transferred to fee-for-service. Now, Medi-Cal plans in all counties must authorize and cover medically necessary SNF services. Recipients enrolled in a Medi-Cal plan will no longer be disenrolled from the plan when they need SNF services.
4. Related legislation. AB 280 (Aguiar-Curry) requires a health plan or insurer to annually verify and delete inaccurate listings from its provider directories; imposes administrative penalties for inaccurate provider directory listings; and, requires out-of-network services to be covered as in-network in specified circumstances due to inaccurate provider directory listings. AB 280 is set for hearing on April 1, 2025 in the Assembly Health Committee.
5. Prior legislation. AB 236 (Holden of 2024) was substantively similar to AB 280. AB 236 was held on suspense in the Senate Appropriations Committee.
6. Support. Sponsors California Advocates for Nursing Home Reform write that Medi-Cal plans cover more than six in 10 nursing home residents in California, but each plan contracts with only a limited number of nursing homes. This means that Medi-Cal recipients must either contact the plan or call individual facilities to find out who contracts with their Medi-Cal plan. They state that they get thousands of calls from across California from individuals needing help to navigate the long-term care system. This will simply require public display of facility information that DHCS already collects. AARP California states that by 2030, one quarter of Californians will be 60 or older, and navigating complex programs and directories is already a challenge for many Californians. This bill would reduce obstacles to accessing information for older adults and individuals with disabilities who are searching for a facility or plan that best fits their needs.
7. Policy Comment. The Health Care Options website is only mandated for those counties that are statutorily organized as multi-plan counties despite the fact that 16 of the 37 single-plan counties also have Kaiser Permanente as a plan option. While Kaiser enrollment is more limited and Kaiser operates in a closed network, Medi-Cal recipients in those counties should be allowed to see what providers are available in each network before making a choice. Although somewhat beyond the scope of this bill, a requirement to add all counties with more than one choice even if they are technically organized as a County-Organized Health System or a single-plan county to the Health Care Options website could be warranted. However, doing so will require some thought as to how to avoid confusing Medi-Cal recipients who are not allowed to enroll in Kaiser.

SUPPORT AND OPPOSITION:

Support: California Advocates for Nursing Home Reform (sponsor)

AARP California

Alzheimer’s Association

Oppose: None received.

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