(The Center Square) – Three different health plans owned by the Centene Corporation have been fined $1.7 million by the state, according to a press release issued by the California Department of Managed Health Care.
The fine was split among the three plans, with Health Net paying $1.2 million, Human Affairs International of California paying $300,000 and Health Net Community Solutions, Inc. paying $200,000, officials from the Department of Managed Health Care said in the press release.
“Delays in finding timely appointments can be a barrier for patients seeking medically necessary care, and can have negative impacts on health plan members,” Kevin Durawa, a spokesperson for the Department of Managed Health Care, told The Center Square via email on Tuesday. “In this case, all three plans failed to report minimum rates of compliance with timely access standards for certain provider networks in their annual surveys of provider networks.
Legislators who sit on health-related committees in the State Senate and State Assembly were not available to comment on the health plan fines on Tuesday.
According to documents pertaining to the fines levied by the Department of Managed Health Care, the Health Net plan – the one that pays the majority of the $1.7 million fine – has to achieve a 70% rate of compliance for both urgent care appointments and non-urgent care appointments. That same document shows that the Health Net plan often had urgent care compliance rates in the between 40% and 60% — oftentimes far below the required compliance rate for patients who needed urgent care services.
Patients have a legal right to timely health care appointments, according to the press release from the Department of Managed Health Care. A fact sheet from the department shows that for urgent care with a health plan that does not require prior authorization, a health plan must provide that coverage within 48 hours. For plans that do require prior authorization, urgent care must be covered by the plan within 96 hours.
Non-urgent care must be covered within 10 business days for visits to a primary care physician, and 15 business days for a specialist, according to the fact sheet. Those who can’t get timely access to an appointment because of their health plan can contact officials who manage the health plan, the fact sheet says.
The first $1 million of fines annually will go to the Steven M. Thompson Physician Corps Loan Repayment Program, which encourages doctors to practice in underserved areas of the state, Durawa told The Center Square via email. The next $4.9 million collected in fines for the 2025-26 fiscal year will go to the Health Care Payments Data Fund to help collect data on health care costs, utilization, quality and equity, and all remaining funds will go to the Health Care Services Plan Fines and Penalties Fund, which supports the Medi-Cal program, Durawa said.
“The goal of all enforcement actions is to get health plans to correct the identified issues and comply with the law,” Durawa told The Center Square via email. “The DMHC will continue to hold health plans accountable to the timely access standards in the law.”
Centene Corporation employees did not respond to calls and emails from The Center Square on Tuesday.
