Blue Shield of California Lawsuit Alleges Department of Health Care Services Failed to Produce Documents in Medi-Cal Procurement

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Oct 07, 2022, 11:05 ET

Nonprofit health plan contends that the State of California has not produced key records and questions credentials of appeals hearing officer

OAKLAND, Calif., Oct. 7, 2022 /PRNewswire/ -- Blue Shield of California has filed legal documents with the State Superior Court seeking a judge to compel the California Department of Health Care Services to comply with the state public records act and release documents related to the state's initial decision on the award of Medi-Cal contracts for 2024.

The Department of Health Care Services recently announced its intent to award contracts to national, for-profit companies beholden to Wall Street. Earlier this year, the state also gave Kaiser Permanente a separate no-bid Medi-Cal contract.

As part of the appeals process, Blue Shield submitted a public records act request to the state seeking crucial information about their scoring process, methodology, and their communications about the bid. Blue Shield also requested that the state-appointed hearing officer provide more time for the appeals process so that each party to the appeal has the opportunity to review all documents related to the request for proposals.

However, the Department of Health Care Services has not provided the requested documents and the hearing officer denied the request for additional time.

"We have waited in good faith and the Department of Health Care Services is refusing to provide the public information we are requesting or to provide a reasonable amount of time for the appeal process," said Kristen Cerf, President and CEO, Blue Shield of California Promise Health Plan.

In addition, the state assigned an employee from its Information Management Division as the hearing officer in this matter; this means an IT professional is responsible for reviewing all appeal materials and making the final decision as to which health plans will be available to millions of Medi-Cal beneficiaries.

"On behalf of the Medi-Cal beneficiaries we serve today whose health care is directly impacted by this decision, and of every Californian, we are turning to the court to insist on a full, fair, and robust Medi-Cal procurement appeals process," Cerf said. "We believe that the Department of Health Care Services has a duty to get this right and not just rubber stamp its original decision."

About Blue Shield of California
Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. Blue Shield of California is a tax-paying, nonprofit, independent member of the Blue Shield Association with 4.7 million members, 7,800 employees, and $22.9 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid, and Medicare healthcare service plans in California. The company has contributed $120 million to Blue Shield of California Foundation in the last three years to have an impact on California communities. For more news about Blue Shield of California, please visit news.blueshieldca.com.