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Molina Healthcare was founded in 1980 by C. David Molina, an emergency room physician in Long Beach, California. [4] He had seen an influx of patients using the emergency room for common illnesses such as a sore throat or the flu because they were being turned away by doctors who would not accept Medi-Cal.
Medi-Cal was created in 1965 by the California Medical Assistance Program a few months after the national legislation was passed. [2] Approximately 15.28 million people were enrolled in Medi-Cal as of September 2022, [3] or about 40% of California's population; in most counties, more than half of eligible residents were enrolled as of 2020. [4]
The lawsuit alleged that Health Net denied claims based on its own definition of "medical necessity" rather than standards set forth by California law. [26] A judge ruled in Health Net's favor in July 2013. [27] In 2016, Health Net Federal Services became a wholly-owned subsidiary of Centene, ending its time as a publicly traded company. [28]
The California Department of Health Care Services (DHCS) is a department within the California Health and Human Services Agency that finances and administers a number of individual health care service delivery programs, including Medi-Cal, which provides health care services to low-income people.
After the passage of the ACA, 32 states used the funding of the ACA to expand their state's low-income insurance programs, such as Medi-Cal, and 19 states opted out. The 19 states, as of 2014, had a 15% higher poverty rate than the 32 states that chose to expand their services. California was one of the states to expand its Medicaid program. [6]
North American Medical Management (NAMM) develops and manages provider networks, offering a full range of services to assist physicians and other providers in their managed care and business operations.
Covered California is governed by a board composed of five members: the Secretary of the California Health and Human Services Agency or their designee as a voting, ex officio member; two members appointed by the Governor; one member appointed by the Senate Committee on Rules; and one member appointed by the Speaker of the Assembly. [20]
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