Director's Office
The Director's Office oversees the organizational purpose of DHCS—to provide equitable access to quality health care leading to a healthy California for all. Coordinating with all programs and divisions of DHCS, the Director’s Office is responsible for policy setting, oversight, and decision making regarding DHCS services, programs and initiatives. The Directorate comprises the Director; Chief Deputy Director, Policy and Program Support; Chief Deputy Director, Health Care Programs; Chief Operating Officer for Programs; Assistant Director; and the State Medicaid Director.
Legislative and Governmental Affairs (LGA)
LGA facilitates, coordinates, and advocates for the development, refinement, and enactment of policy and budget legislation in the interest of public health and the state's health care laws. LGA consults with other DHCS programs and divisions/offices and offers technical assistance to California state legislators and their staff on constituent issues. Additionally, LGA provides information about DHCS' programs and services through briefings, testimonies at informational hearings, and meetings.
Go to
LGA webpage
Office of Communications (OC)
OC is responsible for DHCS communications designed to engage the media, public, intergovernmental organizations, stakeholders, and other groups interested in DHCS’ agenda. OC manages DHCS’ media and public education and outreach activities and oversees its website and social media, managing its content, accessibility, and usability.
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OC webpage
Office of Civil Rights (OCR)
OCR administers and enforces civil rights laws to ensure non-discrimination in all aspects of the access and delivery of health care services provided or administered by DHCS.
Office of Compliance
The Office of Compliance aims to strengthen DHCS' compliance with federal and state laws and regulations by standardizing our approaches for tracking state and federal program requirements, identifying risks, and correcting deficiencies. The Office is responsible for managing, implementing, and leading the Department's internal audits and coordinating waiver submissions to Centers for Medicare & Medicaid Services.
Go to
Office of Compliance webpage
Office of Legal Services (OLS)
OLS provides comprehensive legal services to DHCS' programs and employees. Services include preventive legal advocacy, legislative and policy advice, legal and litigation strategy, Public Records Act request coordination, and litigation support on DHCS matters to the Attorney General's Office. OLS' Office of Regulations and Administrative Services assists DHCS programs with developing and promulgating regulations and other rulemaking activities.
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OLS webpage
Strategic Planning and Workforce Development Division (SPAWDD)
SPAWDD delivers strategies that contribute to DHCS' organizational effectiveness; identifies, develops, and implements initiatives to enhance the culture and support DHCS' purpose; and oversees DHCS' strategic and workforce and succession plans, enterprise governance, and workforce development.
Behavioral Health (BH)
BH leads DHCS' ambitious agenda to ensure high-quality and accessible specialty mental health and substance use disorder services in Medi-Cal and other public programs. Behavioral Health develops and implements policies and initiatives to strengthen behavioral healthcare access, quality, and service delivery, and achieve equitable healthcare outcomes for Medi-Cal members and Californians served through other programs. BH includes California Behavioral Health Planning Council as well as the Community Services, Licensing, and Certification, Behavioral Health Oversight and Monitoring, and the Medi-Cal Behavioral Health – Policy Divisions.
Divisions
California Behavioral Health Planning Council (CBHPC)
CBHPC is a majority consumer and family member advisory body to state and local government, the Legislature, and residents of California on mental health services in California.
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CBHPC webpage
Community Services Division (CSD)
CSD implements and oversees various behavioral health programs and services for adults, youth, and children. CSD certifies, oversees, and monitors adult and children's residential mental health programs and provides oversight of the use of funds from opioid settlements by the state, counties, and local jurisdictions. CSD also administers several federal grants and oversees behavioral health prevention and family services and Proposition 64 youth substance use disorder prevention funding.
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CSD webpage
Licensing and Certification Division (LCD)
LCD licenses certifies, and oversees substance use disorder programs, including driving-under-the-influence programs, narcotic treatment programs, counselor-certifying organizations, outpatient alcohol and/or other drug programs, and residential treatment providers. LCD also licenses and oversees 24-hour psychiatric and rehabilitation care facilities and ensures compliance with statewide criminal justice treatment programs.
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LCD webpage
Behavioral Health Oversight and Monitoring Division (BHOMD)
The Behavioral Health Oversight and Monitoring Division (BHOMD) monitors and oversees County Behavioral Health Plans to ensure compliance with state and federal requirements, regulations, and DHCS contract terms for the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) programs. Other responsibilities within the division include monitoring processes for Medi-Cal, Behavioral Health Services Act (BHSA), Mental Health Block Grant (MHBG), and Substance Use Block Grant (SUBG). BHOMD is also responsible for overseeing and monitoring the implementation of county BHSA-funded programs. BHOMD additionally oversees the implementation and reporting of quality requirements and the network adequacy of SMHS and DMC-ODS programs.
Go to
Medi-Cal Behavioral Health webpage
Medi-Cal Behavioral Health – Policy Division (MCBHPD)
MCBHPD oversees the policy and program areas of the Specialty Mental Health Services, Drug Medi-Cal, and the Drug Medi-Cal Organized Delivery System programs. It oversees State Plan Amendments for County Behavioral Health Plans; California Advancing and Innovating Medi-Cal (CalAIM) behavioral health development and implementation activities; 988 crisis line; Medi-Cal Mobile Crisis Services benefit; Community Assistance, Recovery, and Empowerment (CARE) Act; Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration; and Recovery Incentives Program (contingency management).
Health Care Benefits and Eligibility (HCBE)
HCBE provides leadership for benefits and eligibility policy planning, development, implementation, and evaluation of health care services and delivery systems under Medi-Cal and for the Children's Health Insurance Program (CHIP). HCBE includes Medi-Cal Benefits, Medi-Cal Dental Services, Medi-Cal Eligibility, Office of Family Planning, Office of Tribal Affairs, and Pharmacy Benefits.
Divisions
Benefits Division
The Benefits Division manages and ensures the uniform application of federal and state laws and regulations regarding Medi-Cal-covered benefits, services, and policies affecting Medi-Cal providers and members.
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Benefits Division webpage
Medi-Cal Dental Services Division (MDSD)
MDSD administers the Medi-Cal Dental Services Program for both fee-for-service and dental managed care delivery models. MDSD develops and implements program policy related to the provision of dental services to Medi-Cal members.
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MDSD webpage
Medi-Cal Eligibility Division (MCED)
MCED develops statewide eligibility policies, procedures, and regulations governing Medi-Cal and CHIP and ensures Medi-Cal eligibility is determined accurately and timely per state and federal requirements. MCED also provides counties with administrative funding to perform eligibility activities and reconciles county expenditures on a quarterly basis.
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MCED webpage
Office of Family Planning (OFP)
OFP administers the Family Planning, Access, Care, and Treatment Program, which has been operating since 1997 to provide family planning and reproductive health services at no cost to California's uninsured/under-insured, low-income (under 200 percent of the federal poverty level) residents of reproductive age.
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OFP webpage
Office of Tribal Affairs (OTA)
OTA serves as the principal entity to facilitate engagement among DHCS programs and tribes and Indian health program representatives and urban Indian organizations.
Pharmacy Benefits Division (PBD)
PBD sets policy and coverage for outpatient pharmacy services for the Medi-Cal program. This includes oversight of Medi-Cal Rx, a medical cost-savings initiative, as well as invoicing for and collection of both federal and state supplemental drug rebates. PBD also sets policy and administers the outpatient medical supply and nutritional benefits as well as the Medi-Cal Vision Care program.
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PBD webpage
Health Care Delivery Systems (HCDS)
HCDS develops, implements, and monitors health care delivery to Medi-Cal members through managed care, integrated systems of care, and behavioral health delivery systems. HCDS includes Integrated Systems of Care, Managed Care Operations, and the Managed Care Quality and Monitoring Divisions.
Divisions
Integrated Systems of Care Division (ICSD)
ISCD oversees, operates, and monitors compliance of comprehensive health care delivery systems for vulnerable populations eligible for various DHCS programs, such as the California Children's Services, Genetically Handicapped Persons, and Waiver programs. ISCD also supports other programs serving populations, predominantly children, with complex chronic health conditions.
Managed Care Operations Division (MCOD)
MCOD oversees program and operational activities to provide health care to Medi-Cal members assigned to a managed care plan. MCOD focuses on contract management of the health plans operating under the six main models of managed care and oversees the transitional activities that are necessary when transitioning populations into managed care.
Managed Care Quality and Monitoring Division (MCQMD)
MCQMD oversees and monitors Medi-Cal managed care plans, Medi-Cal and Medicare Dual Eligible Special Needs Plans, and Medi-Cal managed care policy development and interpretation to meet the needs of Medi-Cal members.
Go to
MCQMD webpage
Health Care Financing (HCF)
HCF sets financing policy for the Medi-Cal program, including for the fee-for-service, managed care, and behavioral health delivery systems; county- and school-based services; and safety net provider programs. HCF includes Capitated Rates Development, Fee-for Service Rates Development, Local Governmental Financing, and the Safety Net Financing Divisions.
Divisions
Capitated Rates Development Division (CRDD)
CRDD develops and implements capitation rates for Medi-Cal managed care plans, Medi-Cal Dental managed care plans, and Program of All-Inclusive Care for the Elderly organizations, in compliance with state, federal, and contractual requirements. CRDD also performs financial reviews, monitoring, and oversight of plans to evaluate the financial health and viability of each plan.
Fee-for-Service Rates Development Division (FFSRDD)
FFSRDD develops Medi-Cal reimbursement rates for outpatient and non-institutional and long-term care services that are reimbursed through the Medi-Cal fee-for-service delivery system. FFSRDD represents DHCS on matters pertaining to Medi-Cal rate setting in negotiation and/or meetings with health care provider representatives, patient advocates, external state agencies, representatives of county, state, and federal governments, industry representatives, special interest groups, and other high-level officials.
Local Governmental Financing Division (LGFD)
LGFD provides management and oversight of all county and local government federal reimbursement and financial oversight activities critical to ensuring access to high-quality and cost-efficient health care through DHCS' contracted local governmental agencies. These agencies provide behavioral health care coverage and reimbursement to counties and/or school districts for administrative activities, targeted case management, and certain medically necessary school-based services.
Safety Net Financing Division (SNFD)
SNFD administers payment programs authorized in the Medicaid State Plan and Medicaid Section 1115 waivers using a variety of financing arrangements to maximize provider reimbursements and reduce their uncompensated care costs. SNFD also administers other programs to ensure access to care for California's most vulnerable populations.
Quality and Population Health Management (QPHM)
QPHM leads clinical quality, health equity, and population health work to improve health equity and quality of whole person care for all Medi-Cal members. QPHM includes the Population Health Management Division and Quality and Health Equity Division.
Divisions
Population Health Management Division (PHMD)
PHMD oversees all population health efforts within DHCS, including CalAIM's population health management and Enhanced Care Management to support member care coordination. PHMD oversees DHCS' comprehensive plan to address member needs and preferences across the continuum of care.
Quality and Health Equity Division (QHED)
QHED oversees all DHCS health care clinical quality functions, leads health equity efforts, and coordinates with other areas within the Department, other state departments, county partners, and external stakeholders to achieve DHCS' goal of equitable, high-quality care in Medi-Cal.
Office of Medicare Innovation and Integration (OMII)
OMII works to improve health outcomes, quality, affordability, and equity for Medicare members in California, consistent with the Governor's Master Plan for Aging and CalAIM. OMII partners with teams across DHCS, other state agencies, and stakeholders. Key initiatives include CalAIM Dual Special Needs Plans and efforts to make Medicare enrollment more transparent, improve delivery systems, and increase access to long-term services and supports.
Go to
OMII webpage
Office of Strategic Partnerships (OSP)
OSP leads large-scale implementation of Department-wide initiatives building relationships with non-traditional health-care partners, such as the Children and Youth Behavioral Health Initiative, CalHOPE, and the CalAIM Justice-Involved Reentry Initiative. The Office works directly with stakeholders, providers, counties, health plans, innovation and philanthropy sectors, other state agencies, the Legislature, and numerous statewide organizations.
Administration
Administration provides various central support services to help achieve DHCS program and operations objectives. Administration's services include human resources management, procurement and contracting services, facilities management, and emergency management. Administration includes the Human Resources, Procurement and Contracting, and Program Support Divisions.
Divisions
Human Resources Division (HRD)
HRD provides the full scope of human resources services for DHCS and administers the selections, recruitment, classification, performance management, labor relations, timekeeping, pay and benefits, and disability programs. HRD is responsible for coordinating with and adhering to policies established by the California Department of Human Resources (CalHR). HRD ensures DHCS programs comply with personnel laws, regulations, rules, and bargaining unit contracts.
Procurement and Contracting Division (PCD)
PCD administers the full scope of procurement, contracting, and purchasing services. It is responsible for procurement planning and development, solicitation of bids, including Request for Proposals/offers, and the development and execution of IT and non-IT contracts and purchase orders. PCD works with the Department of General Services (DGS) to complete procurement and contracting services.
Go to
Contracts webpage
Program Support Division (PSD)
PSD supports DHCS’ programs by administrating facilities management, emergency management, health and safety, asset management, forms management, mail operations center, parking and transportation, records management, recycling and e-sustainability management, and fleet management. PSD works with the Department of General Services (DGS) to support DHCS program support needs.
Audits and Investigations (A&I)
A&I is the designated Program Integrity Unit for Medi-Cal, protecting and enhancing the integrity of the health programs administered by DHCS. A&I performs financial and medical audits of health plans and providers and identifies and investigates Medi-Cal provider and member fraud, waste, and abuse. A&I includes Contract and Enrollment Review, Financial Review – Inpatient, Financial Review – Outpatient and Behavioral Health, and Investigations Divisions.
Divisions
Contract and Enrollment Review Division (CERD)
CERD conducts state-mandated medical and contractual compliance reviews of health plans, providers, and Drug Medi-Cal Organized Delivery Systems.
Financial Review - Inpatient Division (FRID)
FRID conducts financial and compliance reviews and audits of Medi-Cal and other DHCS programs' inpatient providers, including acute hospitals and long-term care facilities, to ensure payments to providers of services rendered to Medi-Cal members are valid, accurate, and comply with governing laws, regulations, and program policy.
Financial Review – Outpatient and Behavioral Health Division (FROBHD)
FROBHD conducts financial and compliance reviews of Medi-Cal and other DHCS programs’ outpatient and behavioral health providers, including Federally Qualified Health Centers, Rural Health Clinics, Local Educational Agencies, Targeted Case Management, Ground Emergency Medical Transportation, and behavioral health cost reports.
Investigations Division
The Investigations Division operates the statewide Medi-Cal and other DHCS programs’ fraud, waste, and abuse investigative program, including fraud data analytics, Medi-Cal fraud hotline and complaints, investigative audits, provider fraud investigations, and member fraud investigations.
Enterprise Data and Information Management (EDIM)
EDIM is a data service organization that partners with all DHCS programs to meet their data and information needs. EDIM includes the Data Analytics, Health Information Management, and Program Data Reporting Divisions.
Divisions
Data Analytics Division (DAD)
DAD, in conjunction with the Health Information Management Division, provides leadership and support in the collection, management, analysis, and dissemination of data to support programmatic needs, better serve program members, and improve outcomes.
Health Information Management Division (HIMD)
HIMD, in conjunction with the Data Analytics Division, provides leadership and support in the collection, management, analysis, and dissemination of data to support programmatic needs, better serve members, and improve outcomes.
Go to
HIMD webpage
Program Data Reporting Division (PDRD)
PDRD is the managed care data steward for DHCS. This division leads data projects with DHCS programs and divisions to produce and deliver meaningful health care information through planning, data analytics, and reporting. It receives requests to develop dashboards, projects, extract data and produce data and reports, deliver statistical summaries and data illustrations. All projects completed support DHCS, and managed care programs and evaluations.
Enterprise Technology Services (ETS)
ETS manages Department-wide information technology (IT), including IT strategic direction, enterprise architecture, IT governance, portfolio and project management, IT application and infrastructure operations, and modernization of DHCS’ Medi-Cal Enterprise System. ETS includes Business Operations Technology Services, Information Technology Strategy Services, and the Medi-Cal Enterprise Systems Modernization Divisions.
Divisions
Business Operations Technology Services Division (BOTSD)
BOTSD delivers and manages existing and new technology that supports members, DHCS programs, the California Health & Human Services Agency, and other departments/offices within the Agency. BOTSD ensures compliance with state and federal laws and regulations regarding using information technology and safeguarding electronic information.
Information Technology Strategy Services Division (ITSSD)
ITSSD provides an array of centralized information technology services to achieve DHCS program objectives through business and technology strategy and collaboration.
Medi-Cal Enterprise Systems Modernization Division (MESMD)
MESMD plans and coordinates the transformation of Medi-Cal technology systems. MESMD articulates the future state architecture, roadmaps, and governance for how the technology modernization will be achieved.
Fiscal
Fiscal ensures financial transparency and accountability of DHCS resources and programs by leading the Department’s estimating, budgeting, and financial management and reporting processes. Fiscal includes the Financial Management and Fiscal Forecasting Divisions.
Divisions
Financial Management Division (FMD)
FMD provides fiscal integrity, transparency, and accountability of more than $156 billion annually in federal and state funding. It oversees DHCS’ financial operations, including budget development and management and accounting and reporting.
Fiscal Forecasting Division (FFD)
FFD prepares the twice-annual caseload and funding estimates for the Medi-Cal and Family Health programs.
Office of Administrative Hearings and Appeals (OAHA)
OAHA adjudicates appeals filed by Medi-Cal providers related to a variety of DHCS actions, such as issues arising from financial and rate-setting audits; the renewal, suspension, or revocation of licenses or certifications; the assessment of fiscal sanctions; the suspension of Medi-Cal providers; denials of Medi-Cal provider enrollment applications; and terminations from participation in the Medi-Cal program.
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OAHA webpage
Program Operations
Program Operations enables DHCS to run Medi-Cal and its other health care programs efficiently and consistently with federal and state laws and regulations. Program Operations include California Medicaid Management Information System—Operations, Clinical Assurance, Provider Enrollment, and the Third-Party Liability and Recovery Divisions.
Divisions
California Medicaid Management Information System (CA-MMIS)—Operations Division
The CA-MMIS—Operations Division oversees the Medi-Cal claims payment system that processes approximately $20 billion in payments for nearly 200 million Medi-Cal fee-for-service claims annually and manages multiple vendors responsible for providing information technology and business operations support services for CA-MMIS.
Clinical Assurance Division (CAD)
CAD provides utilization review and oversight of services delivered to more than 700,000 Medi-Cal fee-for-service members (those not in managed care plans). CAD provides post-claim oversight of inpatient hospital services utilizing standardized tools and methodologies to determine medical necessity for hospital days and services to ensure compliance with Medi-Cal policies and applicable state and federal requirements. CAD also provides cost-effective utilization controls by reviewing and adjudicating treatment authorization requests for certain medical procedures, services, and drugs.
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CAD webpage
Provider Enrollment Division (PED)
PED screens, enrolls, monitors, and recertifies the nearly 300,000 Medi-Cal providers that provide services to more than 15 million Medi-Cal members. It reviews applications from and communicates with more than 40 different provider types. It also prepares and delivers training to internal partners and external stakeholders.
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PED webpage
Third-Party Liability and Recovery Division (TPLRD)
TPLRD undertakes multiple recovery and cost avoidance activities to ensure the Medi-Cal program is the payer of last resort, such as seeking reimbursement for services to treat a member’s injury, recouping provider overpayments, collecting taxes and fees due, and monitoring or paying for other health coverage.
Go to
TPLRD webpage
