Challenges · Solutions · Objectives · Fact Sheet

We live in a remarkable age where advancements in medicine are extending our lives, protecting us from many of history’s most debilitating diseases and playing a vital role in the quality of our daily well-being. But medical technology doesn’t come without a price. And, in this era of finite government resources, we face the ongoing challenge of providing quality, cost-effective health care to those in our communities who cannot afford it.

This is the mission and challenge of Medicaid managed care, a term that describes any program or effort designed to improve medical outcomes and control sky-rocketing medical costs by effectively coordinating the delivery of health services to beneficiaries of Medicaid, known as "Medi-Cal" in California. And, from the rich to the poor, from the elderly person to the unborn child, managed care for recipients of Medicaid or Medi-Cal impacts each of our lives, whether it pays for our medical needs or we pay for it through our taxes.

While a variety of managed care programs exist nationwide, the County Organized Health System (COHS) model represents a unique and successful approach that ensures Medi-Cal beneficiaries access to comprehensive and cost-effective health care.

Since the County of Santa Barbara established the first state-contracted County Organized Health System in 1983, four additional California counties have created COHS plans to administer Medi-Cal benefits through local care providers and/or Health Maintenance Organizations (HMOs). Collectively known as the California Association of Health Insuring Organizations, these five COHS organizations now serve as the primary system through which nearly 500,000 of the state’s five million Medi-Cal beneficiaries receive publicly funded health services.

While a number of key features differentiate the County Organized Health System from other managed care models, the underlying force behind the success of California’s five COHS plans is their emphasis on arranging access to appropriate, quality health care services that, collectively, improve the health and wellness of the member communities they serve. Serving the needs of low-income, disabled and long-term care (LTC) Medi-Cal beneficiaries, each COHS plan strives toward 100 percent quality care by providing easy access to health services, case management through primary care providers (PCPs), strong partnerships with the local medical community, local control of funds and policy, ongoing commitment to community needs and values, and plan member advocates.

• To maximize the use of taxpayer funds through cost sharing and the joint development of mutually beneficial programs and activities.

• To promote the effective and efficient operations of all member plans thought the regular sharing of information and expertise.

• To advocate the creation and maintenance of sound health care policy, and promote issues of common interest to the federal government, California Legislature, California Department of Health Services, the California Medical Assistance Commission, and other governmental bodies and professional organizations.

• To develop and implement research, demonstration and educational activities aimed at improving the quality of health care delivery at reasonable costs.

• To provide for a common vehicle of communication and centralized source of information regarding the operations of County Organized Health Systems.

• To increase the knowledge and skills of member plan staff through educational, technological, and training interaction among plans.

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