The First 5 Medi-Cal Learning Community: First 5s Partner with Managed Care Plans on Medi-Cal Transformation

The last four years have been a time of tremendous transformation in the Medi-Cal program, including reforms that impact young children and call on Medi-Cal managed care plans to work more closely with community partners. County First 5s can help Medi-Cal managed care plans achieve these goals because of their expertise in early childhood development and child-serving county systems, their connections to families with young children, and their relationships and contracted partnerships with family-serving community-based organizations (CBOs). 

To ready our network for this opportunity, since 2021 the First 5 Center has engaged county First 5 across the state in Medi-Cal learning. Our goal has been to build foundational knowledge about Medi-Cal among First 5s and provide a space for peer learning. Increasingly state leaders, managed care plans, and providers are looking to collaborate with First 5s in new ways to better serve young children and their families with Medi-Cal coverage, including working together to implement CalAIM and new Medi-Cal benefits.

In 2023, the First 5 Center launched a more formal project to support First 5 Medi-Cal engagement, called First 5 Medi-Cal Learning Community.* This project helps First 5s support the development of local and regional partnerships with managed care plans and provides guidance on the organizational structures necessary to be a contracted partner with plans. Medi-Cal managed care plan partnership with First 5s can catalyze the success of Medi-Cal transformation efforts. In turn, leveraging Medi-Cal supports First 5 in sustaining critical investments in child health like home visiting, as they face declining tobacco tax (Prop. 10) revenue.

The Medi-Cal Learning Community meets monthly and offers 1:1 technical assistance for participants with either First 5 Center staff or our consultants. Of particular note from this work are the Medi-Cal Managed Care/First 5 partnerships emerging across the state for implementation of the Medi-Cal Community Health Worker (CHW) benefit. First 5s invest in many programs that help families access the services they need. These programs are well aligned to health navigation and health education focus of the CHW benefit.​ First 5s can be well-suited entities to act as supervising providers for the CHW benefit, billing Medi-Cal managed care plans for the services they render directly, or through contracts with local CBOs. In this role, First 5s can function as a “hub” or point of contact for Medi-Cal managed care plans in coordinating and managing contracts with multiple CBO’s/direct service providers that serve young children. In turn, First 5s can support local CBOs with the administrative requirements of Medi-Cal billing. 

As First 5s engage in implementation of new Medi-Cal benefits and partner with managed care plans, the First 5 Center also works with the Department of Health Care Services to uplift questions from the network, resources communities need, or challenges First 5s are facing in this work. For instance, recently, the First 5 Center gathered feedback for DHCS on the memorandums of understanding (MOUs) that Medi-Cal managed care plans must hold with First 5s starting next year.

Our work together in the Medi-Cal Learning Community is a new type of collaboration between the First 5 Center, the First 5 Association, and our network. It is also a clear demonstration of the First 5 Association Policy Cycle in action. Although the implementation of these historic changes in Medi-Cal will take time, they follow many years of First 5 and partner advocacy for improved systems and whole-child approaches in health care. In working with our members on implementation, we are seeing the policy process through from policy proposal to impact on the ground with families, and continuously ensuring that the promise of Medi-Cal transformation is realized for California’s young children.

* The MCLC is funded in part by First 5 California Home Visiting Coordination Grants for First 5 counties.