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The DMHC Protects the Health Care Rights of More Than 25 Million Californians

Panel Title IconFor Health Plan Members

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Californians have the strongest patient's rights laws in the nation. DMHC’s Help Center is available to explain your health care rights and help you understand how to use your health care benefits. The Help Center can also resolve problems you may have with your health plan.

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Ensuring prompt and fair payment of health care providers is critical to the stability of California's health care delivery system.  The DMHC’s Provider Complaint Unit can assist California physicians; hospitals and other licensed health care providers resolve disputed claim issues with payers.

Panel Title IconFor Health Plans

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The DMHC licenses and regulates California health plans and strives to streamline the process health plans must follow to comply with the law. This section has all the information and forms plans need to ensure compliance.

What's New

DMHC Fines Anthem $415,000 for Grievance System Violations

Tuesday, May 3, 2016

The California Department of Managed Health Care (DMHC) announced today that it issued a $415,000 fine against Anthem Blue Cross (Anthem) for failing to identify, timely process, and resolve enrollees’ grievances.  Anthem also failed to fully and timely provide information to the Department during the investigation of member complaints.

Timely Access Report

Monday, April 25, 2016

The Knox-Keene Act and DMHC’s Timely Access Regulation requires health plans to provide timely access to care within specified time-elapsed standards. The Timely Access Regulation also requires health plans to submit annual reports detailing compliance rates for each time-specific standard during the previous calendar year. The DMHC reviews the annual reports and posts a Timely Access Report with final findings concerning the submitted data, and recommendations for changes that further protect enrollees.

DMHC Approves Centene’s Acquisition of Health Net

Tuesday, March 22, 2016
California Department of Managed Health Care (DMHC) Director Shelley Rouillard approved Centene’s acquisition of Health Net. The DMHC examines proposed health plan mergers to ensure enrollee health care rights are protected and that enrollees have continued access to appropriate health care services. The DMHC’s approval includes several conditions that will improve access and quality of care, and protect the health care rights of enrollees. More…

RFP No. 15MC-SA011 - Primary Consumer Organization Premium Rate Review

Wednesday, March 9, 2016

The Department of Managed Health Care (DMHC) is seeking a private non-profit consumer advocacy organization to provide input and comments on premium rate review filings. Utilizing rate review criteria adopted under Health and Safety Code Section 1385.03, the Contractor will analyze health plan premium rate filings in order to develop comments on those filings. Comments will be submitted to the DMHC for posting on the DMHC’s website.  More...

Public Meeting on the Acquisition of Cigna by Anthem

Thursday, February 18, 2016

The Department of Managed Health Care (DMHC) invites you to a public meeting on the acquisition of Cigna by Anthem.  Representatives from both plans will be present.  The meeting will be held in Sacramento on March 4, 2016 from 1:30 p.m. to 3:30 p.m.  The purpose of the meeting is to discuss DMHC’s jurisdiction and authority to oversee the transaction and to solicit public comment for DMHC’s consideration as it reviews the transaction.  Public comment will be limited to 3 minutes. Comments may also be submitted to publiccomments@dmhc.ca.gov until 5:00 p.m. on March 11, 2016. 

2014 Annual Report

Thursday, December 3, 2015

The Department of Managed Health Care (DMHC) has issued its 2014 annual report. In addition to serving as the annual report for 2014, the report also celebrates the many momentous anniversaries occurring this year: the 15th anniversary of the creation of the DMHC; the 40th anniversary of the Knox-Keene Health Care Service Plan Act of 1975; and, the 5th anniversary of federal health care reform.  More....

Department of Managed Health Care Strategic Plan 2015 - 2019

Tuesday, September 1, 2015

The Department of Managed Health Care has announced its five-year strategic plan. The strategic plan includes a new mission statement, as well as the core values, goals, objectives and strategies for accomplishing the Department’s mission. This plan was developed with input from DMHC staff and external stakeholders.  More...

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  • Independent Medical Review (IMR)
  • Medical Loss Ratio

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