The Department of Managed Health Care protects consumers' health care rights and ensures a stable health care delivery system in California. The Department achieves this mission by:
- Licensing and regulating managed health care plans, including all Health Maintenance Organizations (HMOs), some Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Medicare Advantage, most Medi-Cal managed care plans, and specialized plans. In total, the DMHC oversees plans that provide comprehensive health coverage to more than 21 million Californians and regulates approximately 90 percent of the commercial health care marketplace in California.
- Enforcing the body of statutes collectively known as the Knox-Keene Health Care Service Plan Act of 1975, as amended.
- Conducting medical surveys and financial examinations to ensure health plans are complying with the law and are financially stable to serve their enrollees.
- Operating a 24-hour-a-day Help Center to resolve health care consumer complaints and administer the Independent Medical Review program.
- Reviewing proposed health plan rate changes for sufficient justification and reasonableness.
- Monitoring the financial solvency of the medical groups with whom health plans contract to provide health benefits to their enrollees.
- Convening the Financial Solvency Standards Board, comprised of people with expertise in the medical, financial and health plan industries, to advise the Director on strategies to keep the managed care industry financially stable.