January 13, 2025

Top News

DHCS Response to Southern California Wildfires

On January 7 and 8, multiple fires erupted in the Los Angeles County area. DHCS is actively engaged in addressing the impacts of the fires. DHCS is working alongside local and federal partners to support health care facilities, ensure continuity of care, and prioritize the safety of affected residents. Specifically, DHCS is coordinating with facilities to manage evacuations and maintain care for residents and is supporting health care providers as they navigate road closures and other disruptions.

DHCS' Emergency and Disaster Assistance Questions & Answers webpage provides guidance and contact information for Medi-Cal members and providers during emergencies. It includes information related to accessing medical care, filling prescriptions, securing transportation, and obtaining support for individuals with specific needs, including people in assisted living facilities and individuals receiving Home and Community-Based Alternatives services.

The California Governor's Office of Emergency Services and the Department of Rehabilitation developed an Emergency Preparedness Guide/Toolkit for Individuals with Disabilities available in multiple languages that includes information and emergency preparedness tips for individuals with specific disabilities. Follow Cal Fire and your local emergency officials for real-time updates about the wildfires, and sign up for local alerts at calalerts.org. Please see the below additional resources for more information:

• CA.gov/LAfires - Provides resources for Californians impacted by the Los Angeles wildfires.
• Listos California - Offers an Emergency Alerts sign-up page to help connect Californians with their local alerts systems based on a provided zip code or location.
• Ready.Gov - Provides guidance for individuals and families to prepare for, respond to, and recover from wildfire events. The resource includes tips for staying safe during wildfires and returning home once an area is declared safe.
• Substance Abuse and Mental Health Services Administration Wildfire Resources - Supports survivors, family members, responders, and recovery workers affected by wildfires and other disasters. Information includes signs of emotional distress, populations who may be at greater risk for distress after a wildfire, and links to resources for more information and support.
• The Centers for Disease Control and Prevention - Provides information on hazards, including wildfires, and offers links to information about staying safe after a wildfire and learning about and coping with hazards linked to wildfires and other disasters.
• American Red Cross - Suggests ways for people who have experienced a residential fire to take care of themselves and their loved ones and to help people who may need assistance. The site lists four steps to take right after a fire and includes links to more information about returning home safely after a fire and recovering emotionally and financially.
  

DHCS remains committed to supporting communities during this challenging time and is grateful to the emergency responders and health care workers on the ground. Stay safe, see official updates for the latest information, and follow evacuation orders issued by local officials.

Proposed DHCS 2025-26 Budget

The proposed 2025-26 Governor's Budget for DHCS allocates $193.4 billion in total funds, including $42.8 billion from the General Fund, and supports 4,821.5 positions. This budget reflects the Administration's continued investment in transforming Medi-Cal into a coordinated, person-centered, and equitable health system for Californians.

The budget prioritizes modernizing the health care delivery system, with a focus on improving accountability and transparency and strengthening community-based care. These strategic investments support DHCS' purpose to provide equitable access to quality health care, leading to a healthy California for all.

Program Updates

State Plan Amendment (SPA) Approved for Dyadic Services

On January 6, the federal Centers for Medicare & Medicaid Services (CMS) approved SPA #23-0010, which authorizes DHCS to utilize an Alternative Payment Methodology (APM) to pay Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Tribal Health Programs, which includes Tribal FQHCs and Indian Health Services-Memorandum of Understanding 638 Clinics, at the Medi-Cal fee-for-service (FFS) rate for dyadic services in certain circumstances. FQHCs and RHCs will receive a separate payment for dyadic services in addition to their standard Prospective Payment Services/All-Inclusive Rate billing payments in certain circumstances.

Dyadic care refers to serving both the parent/caregiver and child together as a dyad and is a form of treatment that targets family well-being to support healthy child development and mental health. Dyadic care fosters team-based approaches to meeting family needs, including addressing mental health and social support concerns, and it broadens and improves the delivery of pediatric preventive care. Offering parents and caregivers mental health services when they bring their babies and children to the doctor is an opportunity to expand access, which can improve outcomes. DHCS will release additional policy guidance in a future Medi-Cal Provider Manual update.

Transition to New Family PACT Portal

From January 13 through February 2, DHCS' Family Planning, Access, Care and Treatment (PACT) program's client eligibility and enrollment transaction services will transition from the Health Access Programs (HAP) Client Eligibility System to a new Family PACT portal. The HAP Client Eligibility System will be disabled on February 3, after which all Family PACT client enrollment, changes, and deactivations will be completed exclusively through the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) Family PACT portal. To support Family PACT providers during this transition, Family PACT providers will have access to comprehensive training materials and webinars through the Family PACT Online Training Center Learning Management System. These resources will ensure that providers are equipped to use the Family PACT portal effectively before its launch.

Policy Adjustment for Medi-Cal Rx Pediatric Integration (PI)

DHCS is making an important policy adjustment related to Medi-Cal Rx's initiative for the reinstatement of prior authorization (PA) requirements and utilization management (UM) claim edits for Medi-Cal members 21 years of age and younger, including members of the California Children's Services (CCS) program. This initiative, commonly referred to as PI, will be implemented on January 31. To directly address and help mitigate stakeholder concerns about the volume of PA requests and potential barriers to timely access that may occur because of PI implementation, as well as recognize the advanced credentialing of CCS Panel Provider Authority, DHCS is adjusting its PI policy approach for continuing therapies/prescriptions PI as follows:

• For a period of no less than 60 days, if a claim would otherwise reject with Reject Code 75 (PA required), but the Medi-Cal member has recent claims history, the claim will pay without the need for additional PA. DHCS intends this approach to afford providers and prescribers additional time to adjust their internal processes and better plan for PI requirements and submit proactive PAs.

DHCS will release additional, more detailed information through the Medi-Cal Rx website and will update various existing resource documents on a flow basis. DHCS remains committed to ensuring Medi-Cal members, providers, and other partners are supported so pharmacy benefits can be accessed in a safe, timely, and equitable manner. DHCS will continue to support and engage stakeholders on PI.

Join Our Team

DHCS is seeking a talented and motivated individual to serve as:

• Chief of the Pharmacy Benefits Division. The Chief is responsible for overseeing the development and implementation of policy, services, and coverage criteria for outpatient pharmacy services for the state's Medi-Cal program. This includes providing policy direction for Medi-Cal Rx as well as invoicing and collecting federal and state supplemental drug rebates. The Chief of PBD also leads the development of nutrition, vision care, and medical supply benefits and oversees the administration of the Medi-Cal Pharmacy and Vision Benefit programs. Applications must be submitted by February 7.

DHCS is also hiring for its accounting, program accountability, behavioral health, managed care quality and monitoring, eligibility, and other teams. For more information, please visit the CalCareers website.

Upcoming Stakeholder Meetings and Webinars

Behavioral Health Transformation Quality and Equity Advisory Committee Webinar

On January 15, from 9 to 11 a.m. PST, DHCS will host the third Behavioral Health Transformation Quality and Equity Advisory Committee webinar. Once registered, you will receive a confirmation email with the webinar link and additional details. DHCS is pleased to continue its collaborative efforts to measure and evaluate the quality and efficacy of behavioral health services and programs. These public webinars provide an opportunity for participants to offer input for DHCS consideration. Visit the Behavioral Health Transformation Stakeholder Engagement webpage for more information about the webinars and additional resources. Please send questions related to Behavioral Health Transformation and/or the webinars to BHTinfo@dhcs.ca.gov.

Smile, California Webinar: Promoting the Medi-Cal Dental Benefit for National Children's Dental Health Month

On January 22, from 11 a.m. to 12 p.m. PST, Smile, California will host a webinar to kick off National Children's Dental Health Month (NCDHM) in February. The webinar will feature a preview of the new Healthy Smile Land materials, strategies for promoting Medi-Cal dental services during NCDHM, and resources for accessing and distributing outreach materials. Attendees will also be able to connect with Smile, California representatives to ask about Medi-Cal dental benefits.

DHCS Harm Reduction Summits

DHCS collaborates with communities across the state to promote harm reduction and low-barrier, patient-centered care within California's substance use disorder treatment system. DHCS encourages substance use disorder treatment providers and staff (including social workers, peers, front desk staff, case managers, nurses, physicians, and all staff in substance use disorder treatment settings) to attend and learn about incorporating the tenets of harm reduction into substance use disorder treatment. Summits will be held in Fresno County (January 23), San Diego County (February 11), and Los Angeles County (February 27). Register on the event website.

Coverage Ambassador Webinar Series: Justice-Involved Reentry Initiative and Children and Youth Behavioral Health Initiative Update

On January 30, from 11 to 11:45 a.m. PST, DHCS will host a webinar for DHCS Coverage Ambassadors (advance registration required). The webinar will provide updates on the Justice-Involved Reentry Initiative and Children Youth Behavioral Health Initiative (CYBHI). It will convey information on justice-involved individuals who are now, or have spent time, in jails, youth correctional facilities, or prisons and who are at higher risk for poor health outcomes, injury, and death than the public. It will focus on significant steps California is taking to improve poor health outcomes for individuals as they prepare to reenter their communities by working to ensure they have continuity of coverage upon their release. Additionally, Coverage Ambassadors will learn how early childhood wraparound services will be expanded through the CYBHI, which will provide mental health services to children, youth, and families. Find out more about DHCS Coverage Ambassadors, or sign up to become a Coverage Ambassador.

Intrauterine Device (IUD) and Contraceptive Implant Insertion Training

On February 19, from 7:30 a.m. to 5:30 p.m. PST, DHCS' Office of Family Planning will host an in-person Comprehensive IUD and Contraceptive Implant Insertion Training. The training, which is currently full, includes information about patient method selection, counseling and consent, techniques for using instruments during IUD placement, and instruction on the insertion of each type of IUD currently available in the United States. Additional topics to be covered include management of side effects, tips for managing difficult placements, pain management principles for office procedures, and prevention and management of complications. Please see IUD & Implant Resources for more information.