In California, state and federal laws impose provider network adequacy standards on all health plans to ensure that plan enrollees can access health care services in a timely manner. While these standards are critical for ensuring that health insurance plans provide meaningful access to necessary care for enrollees, they may put plans at a competitive disadvantage when negotiating contracts with providers such as specialists in short supply. It can be difficult to achieve a balance between cost and access.
Network Adequacy Standards in California: How They Work and Why They Matter examines the existing regulatory framework in California. It reviews standards for network adequacy, availability of waivers for health plans, and the consumer grievance process for patients. California’s requirements are compared to practices in other states and the federal Medicare Advantage program.
The final section of the paper considers new market consolidation forces and discusses the balancing act required within the existing regulatory framework to facilitate affordable health access for all patients in California.