Principales noticias​​ 

Aprobación de la Enmienda de Demostración de CalAIM​​ 

On August 23, the Centers for Medicare & Medicaid Services (CMS) approved an amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration waiver, allowing the state to implement county-based model changes in its Medi-Cal managed care program. The amendment includes expenditure authority to limit the choice of managed care plans (MCPs) in non-rural areas. This authority would apply in the metro, large metro, and urban counties intending to participate in the County Organized Health System (COHS) or Single Plan models.​​ 

For rural counties, CMS approved an amendment to the CalAIM Section 1915(b) waiver on June 26 to limit plan choice in rural counties to participate either in the COHS or Single Plan models. These county-based model changes will go into effect on January 1, 2024. Twelve counties will become COHS and three will become Single Plan model counties. For more information about all counties, their current and 2024 model type, and the MCPs operating in the county, please see the MCP county table.​​ 

Program Actualizaciones​​ 

Medi-Cal Rx​​ 

El 22 de agosto, el Centro de Atención al Cliente Medi-Cal Rx implementó una función interactiva de mejora del reconocimiento de voz para miembros, prescriptores, farmacéuticos y el público en general. Las mejoras incluyen encuestas de llamadas, menús principales para agilizar las llamadas, códigos para informar a los agentes sobre los motivos de las llamadas, vuelta al menú principal para que los llamantes puedan consultar múltiples elementos de autoservicio, y un lenguaje y colocación de las notificaciones mejoradas.​​ 

On August 16, a New Start PA Reminder Alert was published about the prior authorization requirements that will be reinstated beginning on September 22 for new start enteral nutrition products for members 22 years of age and older.​​ 

Medi-Cal para niños y adolescentes enviando información​​ 

On August 25, DHCS distributed an informational mailing to Medi-Cal fee-for-service (FFS) members and/or their parents or guardians about the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, known in California as Medi-Cal for Kids & Teens. The FFS mailing includes: (1) Medi-Cal for Kids & Teens brochures to improve member understanding of how Medi-Cal works for children, teens, and young adults, what it covers, and its role in preventive care screening, diagnosis, and treatment. The child brochure is for children up to age 12, and the teen brochure is for ages 12-20; and (2) “Medi-Cal for Kids & Teens: Your Medi-Cal Rights” guide to help members under age 21 understand their Medi-Cal benefits and their recourse if medically necessary care is denied, delayed, reduced, or stopped. The materials, including translations, are posted on the Medi-Cal for Kids & Teens webpage.​​ 

Únete a nuestro equipo​​ 

DHCS está contratando para nuestros equipos fiscales, de recursos humanos, legales, de auditoría, de políticas de salud y de tecnología de la información. Para obtener más información, visite el sitio web de CalCareers.​​ 

DHCS is dedicated to providing equitable access to quality health care, leading to a healthy California for all. DHCS’ goals and objectives express the tremendous work DHCS is leading to transform our health care system and reflect the organizational culture we are building together.​​ 

Próximas reuniones de partes interesadas y seminarios web​​ 

Seminario web sobre la integración de prácticas informadas sobre el trauma en los servicios de salud reproductiva​​ 

El 30 de agosto, de 12 a 13:30 p.m., el DHCS y el California Prevention Training Center organizarán un seminario sitio web sobre la integración de prácticas informadas en trauma en los servicios de salud reproductiva. La atención informada sobre trauma reconoce la necesidad de comprender las experiencias vitales del cliente para ofrecer una atención eficaz y tiene el potencial de mejorar la participación del paciente, la adherencia al tratamiento y los resultados en salud. Para quienes no puedan asistir al seminario sitio web en directo, habrá una transcripción y grabación del mismo, junto con recursos adicionales, disponibles en la sitio web de Family PACT.​​ 

Seminario web trimestral sobre los programas de salud para indígenas y personas designadas​​ 

On August 30, from 2 to 3 p.m., DHCS will host a webinar (advance registration required) for tribal and Indian health program representatives to provide feedback on DHCS initiatives with specific impact to tribes, Indian health programs, and American Indian Medi-Cal members. The webinar will provide information about State Plan Amendments, waivers, and demonstrations proposed for submission to CMS, including the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Medicaid section 1115 demonstration and transitional rent services amendment to the CalAIM section 1115 demonstration. Email questions or comments to TribalAffairs@dhcs.ca.gov.​​ 

Seminario web del Programa de Pagos de Transformación de la Equidad y la Práctica​​ 

On August 30, from 3 to 4 p.m., DHCS will host an Equity and Practice Transformation Payments Program Webinar (advance registration required) to share an update on the Equity and Practice Transformation Payments Program, which is a one-time $700 million primary care practice transformation program initiative to advance health equity and population health and invest in upstream care models. Details about the Provider Directed Payment Program will be discussed during the webinar; the program application and other materials will be posted on the DHCS website in the future. Please email ept@dhcs.ca.gov with any questions.​​ 

Embajadores de la cobertura del DHCS: Seminario web de formación de formadores​​ 

On August 31, from 10 to 11:30 a.m., DHCS will host a webinar on Coverage Ambassadors: Train the Trainer. The webinar will serve as a training session for Coverage Ambassadors to better assist their communities as California resumes standard Medi-Cal operations and communicates the importance of members renewing their Medi-Cal coverage. The webinar will also describe the resources available and how to use them. For more information, visit the Coverage Ambassadors Coverage Ambassadors webpage. Join the Coverage Ambassadors mailing list to receive the latest information and updated toolkits as they become available.​​ 

Seminario web sobre la reforma del financiamiento de los centros de enfermería​​ 

On September 7, from 2 to 3 p.m., DHCS will host a virtual stakeholder webinar to discuss the development of the Skilled Nursing Facility Workforce Standards Program and provide updates on other nursing facility financing reform programs authorized by Assembly Bill 186 (Chapter 46, Statutes of 2022). Stakeholder input will be accepted. Additional information is available on the Nursing Facility Financing Reform (AB 186) webpage.​​ 

Seminario web del Programa de Cobertura de Audífonos para Niños (HACCP) para familias y socios comunitarios​​ 

On September 12, from 11 a.m. to 12 p.m., DHCS will host a HACCP webinar to share guidance with families and communities about applying for hearing aid coverage and helping children to maximizing their HACCP benefits once enrolled. DHCS welcomes newly interested families, those who are currently participating in HACCP, and community partners supporting families and children to join this webinar for program updates, tips, and a Q&A session. For more information, please visit www.dhcs.ca.gov/haccp.​​ 

Reunión del Grupo de Trabajo de Implementación de Doulas​​ 

El 14 de septiembre, de 12 a 14 horas, DHCS acogerá la tercera reunión del Grupo de Trabajo de Implementación de Doulas. Un enlace para escuchar la reunión se publicará en los Servicios de Doulas como sitio web de beneficios Medi-Cal antes del 31 de agosto. La reunión incluirá un reporte sobre la propuesta de la Vía de Atención al Parto de DHCS, el papel de las doulas y la planeación de futuras reuniones. El grupo de trabajo es responsable de revisar cómo aumentar la disponibilidad de servicios de doula mediante Programeducativas de divulgación, identificar y minimizar barreras a los servicios de doula y abordar los retrasos en los pagos y reembolsos a doulas y miembros.​​ 

Seminario web para proveedores médicos y profesionales de la audición​​ 

On September 14, from 12 to 1 p.m., DHCS will host a HACCP webinar to share information with providers to help pediatric patients and their families maximize HACCP benefits. The training session will address program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, physicians, and their office staff. For more information, please visit www.dhcs.ca.gov/haccp.​​ 

Por si te lo perdiste​​ 

California amplía el acceso al tratamiento de opioides en cárceles y tribunales de drogas​​ 

On August 22, DHCS announced it will expand Medication Assisted Treatment (MAT) to jails and drug courts it will expand Medication Assisted Treatment (MAT) to jails and drug courts. The $2.9 million in funding will go to 29 counties to support the development or expansion of access to MAT. By bringing county teams together in a learning collaborative, county agencies and providers serving justice-involved residents can more effectively coordinate and further build system capacity to ensure access to effective treatment and recovery supports. This expansion will better serve residents in need, and MAT, specifically, has been shown to reduce criminal activity and reincarceration to better serve the entire community.​​ 

El estado extiende la asociación con la Iniciativa de Escuelas CalHOPE​​ 

On August 24, DHCS announced the extension of the CalHOPE Schools Initiative through June 30, 2024 the extension of the CalHOPE Schools Initiative through June 30, 2024. The initiative provides free resources for school personnel, youth, and parents surrounding three powerful films that address student social-emotional and mental health needs: A Trusted Space: Redirecting Grief to Growth, Angst: Building Resilience, and Stories of Hope Shorts.​​ 

Opinión semanal del Capitolio sobre las redeterminaciones de Medi-Cal​​ 

El 20 de agosto, Capitol Weekly publicó una opinión del CEO de LA Care, John Baackes. LA Care es uno de los planes Medi-Cal Managed Care del condado de Los Angeles . Baackes hizo un llamado a "todos nosotros – vecinos, socios en el gobierno y defensores de la comunidad – a hacer todo lo posible para mantener asegurados a nuestros colegas y vecinos" por Medi-Cal.​​ 

Al interactuar con los afiliados a Medi-Cal, por favor comparte con ellos consejos útiles para mantener su cobertura. Si la fecha de renovación de su elegibilidad fue en junio o julio, no es demasiado tarde. Pueden devolver su paquete de renovación de Medi-Cal a la oficina local del condado hoy mismo para que recuperen su cobertura en la fecha original de renovación. Además, si los afiliados a Medi-Cal se mudaron o su información de contacto cambió en los últimos años, deberían cerciorar de que la oficina local del condado tenga su información actual para poder contactar con ellos con información importante sobre renovaciones. Y si los miembros reciben un paquete de renovación de Medi-Cal por correo en un sobre amarillo, deben actuar rápidamente para mantener a sí mismos y a sus familias cubiertos con los documentos de renovación que devuelven.​​