A proposed no-bid Medi-Cal contract for Kaiser could signal the end of a public health system.

Four decades ago, California embarked on a way to create a health care safety net for low-income residents who receive the state’s version of Medicaid, known as Medi-Cal, through publicly-governed nonprofit entities called the County Organized Health System. In Monterey County, 1 out of every 3 residents is a Medi-Cal member of the COHS nonprofit Central California Alliance for Health.

The future of that system is now in doubt, according to critics of a state plan to award a no-bid contract in 2024 to Kaiser Permanente to care for Medi-Cal patients in 32 counties without organized systems. They say the five-year contract could be disruptive and potentially harmful to the COHS counties by excluding patients with the most care needs, among other problems.

Department of Health Care Services officials argue that Kaiser has “the highest-quality plan” and offers clinical expertise.

Assembly Bill 2724, which would codify the proposal and is now making its way through the Legislature, is opposed by COHS counties. A letter dated April 12, signed by the chairs of 10 boards of supervisors, including Monterey County’s Mary Adams, detailed the reasons they oppose, concluding it was important to “uphold the integrity of the COHS model.”

The state’s announcement in February came after a year-long process for new counties to organize systems similar to The Alliance, says Alliance CEO Stephanie Sonnenshine. “This is a really significant departure from public policy,” she says, because it allows a commercial entity to take over a significant portion of the state’s Medi-Cal program with no public representation in its governance.

Sonnenshine was disappointed by recent comments made in the Assembly Health Committee, where members downplayed opponents saying they were afraid of change. “This isn’t just change, this is ending the County Organized Health System model,” she says.