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What's New

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 Approves Centene’s Acquisition of Magellan with Conditions to Protect Consumers

The California Department of Managed Health Care (DMHC) approved Centene Corporation’s (Centene) acquisition of Magellan Health, Inc. (Magellan) with conditions to ensure the merger does not adversely impact enrollees or the stability of California’s health care delivery system.

HAI-CA and MHSC filed notices with the DMHC outlining the proposed acquisition and change of control on January 12, 2021. The Department determined the transaction met the requirements of a major transaction in the law on March 12, 2021, requiring the Department to hold a public meeting and obtain an independent impact analysis on the merger. The DMHC held a public meeting on October 27, 2021.

More information can be found in the press release or the DMHC Mergers webpage.

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.

DMHC Report Shows Prescription Drug Costs Increased $1.5 Billion Over Four Years

The Department of Managed Health Care (DMHC) released the Prescription Drug Cost Transparency Report for Measurement Year 2020. The report looks at the impact of the cost of prescription drugs on health plan premiums and compares this data over four reporting years: 2017, 2018, 2019 and 2020. Among other findings, the report reveals that health plan spending on prescription drugs increased by $1.5 billion since 2017, including an increase of $500 million in 2020.

DMHC Reviewing the Acquisition of Magellan by Centene

The Department of Managed Health Care (DMHC) is currently reviewing the acquisition of Human Affairs International of California (HAI-CA) and Magellan Health Services of California, Inc. – Employer Services (MHSC) and MHSC’s indirect parent, Magellan Health, Inc. (Magellan) by Centene Corporation (Centene). The Department held a public meeting on October 27, 2021, and accepted public comments at the meeting. Additionally, the public had an opportunity to submit written comments on the transaction until 5 p.m. on November 3, 2021. The DMHC is considering the public comments submitted as the Department continues to review the transaction.

The DMHC issued a finding that the acquisition of Magellan by Centene is a “major transaction or agreement” under Health and Safety Code (HSC) Section 1399.65. Upon due consideration, the Department determined that the specific facts of this change of control meet criteria set out in Section 1399.65, subdivision (g)(1). Accordingly, the change of control proposed through the Notices is a major transaction or agreement, and a public meeting and independent analysis is required as set forth in Section 1399.65, subdivisions (a)(4) and (c). The public may view the Independent Analysis Report pursuant to HSC Section 1399.65(a)(4) and 1399.65(b).

For more information, visit the DMHC Mergers webpage.

2018 Annual Report and Infographic

The Department of Managed Health Care 2018 annual report and infographic are now available online. Both of these documents highlight the DMHC’s activities during 2018 and include key statistics about the Department.

2018 DMHC Annual Report2018 DMHC  Infographic

CDPH COVID-19 Updates

DMHC COVID-19 Updates

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