Oversight of the quality of care provided by Medi-Cal Managed Care (MMC) plans is an increasingly important issue for the Legislature to examine, as MMC enrollment and the geographic reach of MMC have grown significantly over the past decade. In this report, we analyze the quality of MMC plans and current DHCS efforts to improve MMC plan quality, and consider additional steps and alternative approaches, such as P4P, the state could take to monitor plans and stimulate quality improvement in MMC.