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What's New

State Fines L.A. Care Health Plan $55 Million in Enforcement Action to Protect Consumers

The Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) have taken action against Local Initiative Health Authority for Los Angeles County (L.A. Care) to protect the plan's members. The two departments' actions against the state's largest Medi-Cal plan include penalties of $55 million. This consists of a $35 million penalty from the DMHC and $20 million sanction from the DHCS.

"The magnitude of L.A. Care's violations, which has resulted in harm to its members, requires immediate action," said DMHC Director Mary Watanabe and DHCS Director Michelle Baass in a joint statement. "Our investigations found several operational failures at L.A. Care, which have significantly impacted the health and safety of some of the state's most vulnerable health care consumers. This action is necessary to protect the plan's members, and to get L.A. Care to make serious changes to repair the plan's operations."

The two departments conducted coordinated investigations into the plan's violations and worked together on the respective department actions. The departments' investigations found several violations by the plan, including L.A. Care's handling of enrollee grievances, the processing of requests for authorization, and inadequate oversight and supervision of its contracted entities regarding timely access.

DMHC APL Reminds Health Plans of Federal Requirement to Cover At-Home COVID-19 Tests

Beginning January 15, 2022, health plans must cover at least eight (8) over-the-counter (OTC) COVID-19 tests per enrollee per month. Health plans can arrange with a network of distributors (e.g., pharmacies and retailers) to provide direct coverage of the tests, in which case enrollees would be able to obtain the tests from an in-network source without paying out-of-pocket and then seeking reimbursement from the plan. Alternatively, enrollees may purchase the tests themselves and seek reimbursement up to the amount allowed by the federal guidance. Plans may not impose any prior authorization or cost-sharing requirements as a prerequisite for an enrollee obtaining OTC COVID-19 tests. Likewise, an enrollee does not need to first have an order or individualized clinical assessment from a provider to obtain coverage for OTC COVID-19 tests.

DMHC APL 22-005 - Federal Requirement to Cover At-Home COVID-19 Tests Purchased Over-the-Counter

DMHC Consumer Fact Sheets on COVID-19 Tests & Vaccines

The DMHC is taking action to protect consumers’ health care rights and ensure a stable health care delivery system during the COVID-19 pandemic. The Department is working closely with state and local leaders, health plans, providers and others in supporting actions to mitigate the spread and severity of COVID-19. This includes creating fact sheets to inform consumers about their rights to access free COVID-19 tests and vaccines:

Consumer Fact Sheet on COVID-19 Testing

Consumer Fact Sheet on COVID-19 Vaccines

More information about the DMHC’s actions related to COVID-19 is available on the DMHC COVID-19 Response webpage.