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With an intimate knowledge of Medi-Cal and California healthcare, Gelmy Ruiz ensures regulatory compliance and prepares clients for successful audits. Working at the intersection of policy and practice, she has significant experience collaborating with governmental payers, safety net systems and health plans. Gelmy analyzes contracts, interprets reporting requirements, and translates new regulation into sustainable action.
Gelmy joined HMA from California Health & Wellness (CHW), a Centene-operated Medi-Cal managed care health plan serving California’s 18 northern rural counties and one southern border county. As a compliance manager, she coordinated with business team leads to prepare regulatory audits. Gelmy was among the first wave of hires brought on to implement the health plan in 2013 – assisting in the creation of policies and procedures and the review of processes and documents to ensure compliance with the California Department of Health Care Services contract and state regulations.
In various compliance-focused roles with CHW, Gelmy managed the plan’s relationships with both the state Medicaid and health plan regulators and reviewed and submitted regulatory reports. She created a new committee to streamline review and approval of all departmental policies and procedures, and she supervised clerical compliance and collaboration within departments.
Prior to CHW, Gelmy served as a senior compliance analyst at Health Net, Inc., a California-based Medicaid, Medicare and commercial health plan. She oversaw day-to-day operations of the Healthy Families contract and administered the Medicaid required reports. Gelmy managed the regulatory relationship with the Managed Risk Medical Insurance Board. Additionally, she directed the plan’s activities to shift Health Net’s Healthy Families enrollees into the Medi-Cal M-CHIP successor program.
Gelmy has also held positions with the Health Plan of San Mateo as a long-term care specialist and with San Mateo County’s correctional health unit where she coordinated the accreditation review of the medical unit.
Gelmy received her master’s degree in public administration from California State University in Hayward. She received her bachelor’s degree in psychology with a minor in Spanish from Saint Mary’s College of California. Following her graduate studies, she served as a CSU executive fellow with the California Conservation Corps.
Fluent in Spanish, Gelmy was born in Nicaragua and loves to travel. When she is not globetrotting, she is reading, gardening or playing volleyball.