“CenCal Health (CenCal) has reached a settlement agreement with the Department of Justice (DOJ) and other regulators regarding the disbursement of Medicaid funding through the Affordable Care Act (ACA) between 2014 and 2016. This settlement marks the conclusion of the government’s eight-year-old payment dispute with CenCal and the settling providers.
ACA funds were made available for CenCal’s community of health care professionals to provide services to the then-newly eligible Medi-Cal beneficiaries. CenCal’s work was done publicly and transparently and aimed at coordinating the health care needs of 16,000 formerly uninsured individuals who obtained coverage under the ACA. Those funds were not retained by CenCal for its own purposes, but instead used to support the most vulnerable in our community.
CenCal disagrees with the government’s position: We believe these past disbursements to providers under this program were lawful and proper, and made in good faith within the context of minimal regulatory guidance. Regardless, we agreed to settle and put this matter behind us, allowing us to refocus on our mission – improving the health and wellbeing of the people we serve by providing access to high-quality health services.
Under the settlement agreement, CenCal will pay $49.5M and enter into a Corporate Integrity Agreement for a period of five years. We wish to move forward proactively and productively with the government, reflecting our values of compassionate service, integrity, collaboration and improvement. As a trusted leader in advancing health equity, we remain focused on our important mission so that our communities thrive and achieve optimal health together.”
About CenCal Health
CenCal Health is the local Medi-Cal health plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering health care services to over 225,000 members in its two-county service area – one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County. Marking 40 years of serving the most vulnerable, CenCal Health prioritizes cultivating community partnerships; advancing quality and health equity; expanding its service role and reach in the community; and organizing for impact and effectiveness. With a vision to be a trusted leader in advancing health equity so that the communities we serve thrive and achieve optimal health, CenCal Health invites the public to review its 2023-2025 Strategic Plan at wwwqa.cencalhealth.org/strategicplan.