Voluntary employees’ beneficiary association pilot program

The pilot lets a voluntary employees’ beneficiary association with more than 100,000 enrollees pay providers through risk-based arrangements rather than solely fee-for-service. The extension preserves testing of whether that model lowers costs and improves care while requiring state intervention for serious negative findings.

What the law does ​

• Extends the pilot program’s end date from December 31, 2027, to December 31, 2030.
• Extends the underlying law’s repeal date to January 1, 2031.
• Requires the Department of Managed Health Care to submit an interim evaluation to the Legislature before January 1, 2029, covering costs, patient outcomes, satisfaction, grievances, appeals, and independent medical reviews through 2027.
• Requires the department to end the pilot early if reports show significant negative findings, including serious deficiencies that could harm enrollees.
• Allows the department to terminate the pilot for inadequate enrollee protections or failure to meet program requirements.

Who it affects ​

• Voluntary employees’ beneficiary associations with more than 100,000 enrollees participating in the Southern California pilot.
• Participating health care providers that accept global or other risk-based payments.
• Employees and other enrollees receiving coverage through a participating association.
• The Department of Managed Health Care.

Context ​

Participating providers and associations must report cost, clinical-outcome, and enrollee-satisfaction data, and participants reimburse up to $500,000 of the department’s regulatory costs.