California’s Medicaid program is undergoing major changes in the new year aimed at improving health care access and delivery for people enrolled in the safety net program. But state regulators will need to rigorously enforce the improvements.

The changes are embodied in a new contract between California and the managed care plans that serve 99 percent of Medi-Cal enrollees. The state is tightening enforcement of certain quality measures. For the first time ever, the plans will be required to invest a portion of their profits into the communities they serve.

They’re also required to report publicly on the performance of medical providers---and reveal the number of enrollees who don’t have access to primary care---then invest more to plug any gap.

Additionally, the plans must better integrate physical and mental health care; respond to the cultural and language preferences of their members, as well as sexual orientation and gender identity.

The contract includes key elements of CalAim, a 12-billion-dollar state initiative, which requires health plans to better coordinate care for the neediest Medi-Cal members.