Podcast Summary

Becker’s Healthcare Podcast

Episode: Navigating Medicaid Redeterminations and Market Shifts with CalOptima Health Leadership
Date: February 28, 2026
Guests: Michael Hunn (CEO, CalOptima Health) & Yunkyung (YK) Kim (COO, CalOptima Health)
Host: Jacob Emerson

Episode Overview

This episode delves into the challenges and strategies surrounding the Medicaid redetermination process, looming market shifts, and CalOptima Health’s plans to navigate these changes. Michael Hunn and YK Kim discuss both operational and community-based solutions to policy adjustments, particularly in California, and provide insights on leadership during turbulence in the healthcare industry.

Key Discussion Points and Insights

1. Leadership Backgrounds and Organizational Roles

• Michael Hunn’s Career Trajectory

  • Extensive acute-care leadership: psychiatric, long-term care, community, and tertiary hospitals.
  • Past CEO roles across 12 hospitals, six systems, latest at Providence Health System, SoCal.
  • Medicaid health plan leadership for a decade.
  • (01:06) “I actually became a CEO at age 36. So I've been sitting in the chair a lot of years.” — Michael Hunn

• YK Kim’s Experience in Public Payer Space

  • 25 years in Medicaid and related programs in California (public plan, for-profit, nonprofit).
  • CO*O at CalOptima Health for over 4 years, leading core operations, provider partnerships, quality, and technology.
  • Special focus on Medi-Cal, Dual Eligibles, Medicare, ACA, and PACE.
  • (02:12) “My area of interest has always been in the Medicaid program and then the programs that serve the families and communities around Medicaid.” — YK Kim

2. Preparing for Medicaid Redeterminations (HR1)

• $20 Million Investment in Outreach

  • CalOptima has allocated ~$20M to ensure members are informed and don’t lose coverage due to miscommunication around eligibility changes.
  • Initiatives include member and provider education campaigns, internal team trainings, and coordinated information sharing.
  • (04:54) “We have committed nearly $20 million to outreach, navigation, education, information campaign to make sure that no one is losing coverage because they don't understand the changes…”

• Provider Collaboration & Planning

  • Directly supporting providers to help anticipate and plan for coverage changes and patient volume fluctuations.
  • Sharing projections and encouraging practical adjustments at the point of care to mitigate operational disruptions.

• Access Expansion

  • Promoting regular healthcare access for all eligible members as long as possible.
  • Supporting provider offices to maintain care and reimbursement processes.

3. Risk of Coverage Loss & Impact on Community Care

• Hospital Forums and Coordination

  • CalOptima holds quarterly meetings with CEOs from 44 hospitals in Orange County to discuss enrollment trends and implications.
  • Emphasis on forecasting uncompensated/charity care due to coverage losses and supporting continuity of care (especially prescriptions for chronic disease).

• Unified Communication for Members

  • Standardized FAQs and information are coordinated across CalOptima’s call center, county agencies, hospitals, clinics, and community navigators.
  • (11:50) “We have coordinated our FAQs with… our call center… county, hospitals, clinics… so that no matter when the question gets asked… they get the same answer on what to do.” — Michael Hunn

• Advice for Hospital Executives

  • Urges hospital leaders to proactively partner with local Medicaid plans and social services teams to prepare for patient and financial impacts.

4. CalOptima’s ACA Marketplace Plans for 2027

• Local, Affordable Option Despite Market Challenges

  • CalOptima is proceeding with a 2027 Covered California marketplace launch, targeting members who “churn” in and out of Medi-Cal eligibility (approx. 15,000 initially projected).
  • Current market difficulties noted: end of enhanced tax credits, national drop in enrollment, premium volatility.
  • (13:32) “We are still working towards a 2027 launch. We are right now in the depths of applications and licenses and working with our providers on contracts…” — YK Kim

• Rationale and Community Focus

  • Marketplace plan seen as critical to maintaining continuity for families facing eligibility changes, offering a trusted, local health plan.
  • Acknowledgement that economic and policy shifts may affect enrollment numbers, but commitment to remain regardless of market size.
  • (14:40) “While costs may be rising, I think that speaks to an even more critical reason as to why a public plan like CalOptima Health would consider entering the market…”

5. Leadership Reflections and Retirement

• Building Trust & Community Partnerships

  • Michael Hunn emphasizes trust developed with members and community partners as his proudest achievement at CalOptima.
  • Growth in community involvement seen as a key indicator of success (from small gatherings to 4,000+ at recent events).
  • Effective collaboration with clinics, schools, city governments, and legislators noted.
  • (16:45) “What I'm most proud of is the fact that we have built trust with our members and in the community…”

• Guiding Principles for Healthcare Leaders

  • Michael Hunn’s Leadership Advice:
    • Address problems head-on: “I’m not here to admire the problems.” (19:22)
    • Focus on results: “Don’t confuse activity for accomplishment.” (19:22)
    • Lead with mission and kindness: “You have to love what you do… show up with a spirit of kindness.” (19:22)

Notable Quotes and Memorable Moments

• Importance of Unified Communication

  • (11:50) Michael Hunn: “...no matter when the question gets asked by a Medi-Cal or a Medicaid member, they get the same answer on what to do, how to do and maybe where to go.”

• Marketplace Launch Motive

  • (14:40) YK Kim: “We want it to be a local, affordable option for our members and their families when their life circumstances change… a familiar health plan who has known their health care and known their family's health care.”

• Leadership in Change

  • (19:22) Michael Hunn: “Don’t confuse activity for accomplishment… If you can’t put a number up on the board... for the member, it’s not that I called them five times to get a doctor appointment. It’s I called them, I got the doctor appointment and they went to the doctor—checkmark.”

• Advice on Collaboration

  • (20:42) YK Kim: “We don’t do health care alone… We won’t get through this if we… just protect ourselves. It’s a real important time for us to be reaching out to each other for payers to reach out to providers and vice versa…”

Timestamps for Key Segments

• 01:06 – Michael Hunn’s background in acute healthcare and transition to Medicaid
• 02:12 – YK Kim’s career in public payer and Medi-Cal operations
• 04:54 – CalOptima’s $20M outreach and education initiative for redeterminations
• 08:36 – Risk of uncompensated care: hospital CEO collaboration and planning for member coverage loss
• 11:50 – Standardizing communication and FAQs across ecosystem
• 13:32 – Marketplace plan updates and rationale amid shifting national trends
• 16:45 – Michael Hunn’s reflection on building community trust as CalOptima CEO
• 19:22 – Leadership principles for managing change
• 20:42 – Final thought: the necessity for payer-provider partnership moving forward

Overall Tone:
Encouraging, practical, community-oriented, and deeply focused on collaboration and clear communication—anchored by the guiding values of both leaders.

This summary captures the episode’s essential discussion threads, key operational insights, and the leadership outlook at CalOptima Health as they brace for a turbulent policy environment in Medicaid and beyond.