The Department of Managed Health Care (DMHC) is a regulatory agency that regulates managed care plans, including health maintenance organizations (HMOs) and most Medi-Cal managed care plans in California. The DMHC was created as the nation’s first state department dedicated solely to regulating managed care plans and helping consumers resolve disputes with their health plans. The DMHC Help Center informs consumers of their health care rights, addresses consumer complaints, helps consumers navigate and understand their coverage, and provides timely access to appropriate health care services helps in the field.
The DMHC Help Center provides direct assistance to health care consumers in all languages through the Department’s website, www.HealthHelp.ca.gov, and toll-free telephone number, 1-888-466-2219.
Mary Watanabe is currently the director of DMHC. DMHC is part of the California Health and Human Services Agency. Established in 2000, it is responsible for enforcing the Knox-Keen Health Care Services Plan Act of 1975 and other related laws and regulations.
Dual health insurance regulation
DMHC administers the majority of state-regulated health care coverage in California, and state-regulated plans comprise 96% of enrollments in commercial and government health care plans. However, not all health plans operating in California are under the jurisdiction of the DMHC; For example, some preferred provider organizations are regulated by the California Department of Insurance (CDI). Two state health insurance regulators are unusual in the United States and have led to several additional obligations to harmonize laws. This dual rule arose for historical reasons, and when the DMHC was created in 2000, the California Legislature required a report on the merger of the responsibilities of health insurers with the CDI. In 2001, J. Clark Kelso, who served as California's acting insurance commissioner in 2000, outlined the costs and benefits of agency consolidation.
Additionally, the federal government regulates health insurance for members of the military, and "self-insured" or ERISA plans offered by some large employers are covered by the U.S. Department of Health and Human Services.
Knox-Keene licenses
In 2022, 97 DMHC-chartered full-service health care plans provided health care services to 29.7 million Californians. This included 13.8 million commercial enrollees and about 15.8 million government enrollees. In addition to full-service health care plans, DMHC oversees 46 specialty health care plans, including chiropractic, dental, vision, behavioral health (psychological) and pharmacy.
History
The agency was created in July 2000, amid widespread dissatisfaction with managed care across the country and in response to concerns that the previous regulator, the California Department of Corporations, lacked expertise in health care protections and consumer. When it was founded, California was the largest market for healthcare organizations (HMOs) in the United States.
After construction, Kaiser Permanente challenged its authority in court, but was unsuccessful.
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