Medi-Cal Targeted Rate Increases (TRI)Pursuant to Assembly Bill (AB) 118 (Chapter 42, Statutes of 2023), DHCS published, as part of the proposed 2024–25 Governor's Budget, a plan for targeted increases to Medi-Cal payments or other investments, effective in 2025, across primary care, maternal care, behavioral health care, specialty care, women's health services, public hospital services, community and hospital outpatient services, emergency services, and other domains. The proposed investments will be supported with funding from the
Managed Care Organization (MCO) Tax, authorized by AB 119 (Chapter 13 , Statutes of 2023), and are designed to advance access, quality, and equity for Medi-Cal members and promote provider participation in the Medi-Cal program. These proposed investments are subject to obtaining all necessary legislative and federal approvals, as applicable. For more information, please visit the
Medi-Cal Targeted Provider Rate Increases and Investments webpage and view the
Medi-Cal TRI policy paper and
MCO Tax-funded investments.
Extension of Continuous Coverage Unwinding Waivers and Flexibilities
On December 18, 2023, the Centers for Medicare & Medicaid Services (CMS) released an
Informational Bulletin regarding maintaining coverage under Medi-Cal for children. This bulletin extended all unwinding waivers and flexibilities through December 31, 2024. Throughout the continuous coverage unwinding period, DHCS has applied and received approval for several federal waivers and flexibilities outlined in the
Medi-Cal COVID-19 Public Health Emergency and Continuous Coverage Unwinding Operational Plan. The waivers and flexibilities were designed to streamline renewal processing for Medi-Cal members, ease requirements to provide additional paperwork or documentation, and reduce procedural terminations. Previously, these waivers were approved through the end of the unwinding period, which concludes in May 2024. Additional guidance will be forthcoming from CMS to all states.
Program Updates
Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 3 Application Opening
On January 15, DHCS opened the PATH CITED Round 3 application window. The PATH CITED initiative provides funding to build the capacity and infrastructure of on-the-ground partners, including community-based organizations, public hospitals, county agencies, tribes, and others, to successfully participate in Medi-Cal. The deadline to apply for PATH CITED Round 3 funding is February 15. The below events will serve to assist prospective applicants:
PATH Collaborative Planning and Implementation (CPI) Best Practices Webinar #2 Materials Now Available
On December 7, DHCS hosted a public webinar, entitled “Relationship Building with Organizations in the California Advancing and Innovating Medi-Cal (CalAIM) Environment." Please visit the PATH CPI website to access and share the webinar recording and slides and learn how to:
- Identify the unique value of an organization as a strategic partner for key stakeholders within CalAIM.
- Use a structured relationship mapping process to create an action plan for improved collaboration and engagement with fellow Enhanced Care Management (ECM) and Community Supports providers and Medi-Cal managed care plans (MCP).
Best Practices webinar materials will continue to be published on the
PATH CPI website under the “Best Practices and Resources" section. Information about the next Best Practices webinar will be shared in the coming months.
Join Our Team
DHCS is hiring:
- Chief of Capitated Rates Development Division within Health Care Financing serves as the principal policymaker for all rate-setting activities to ensure high-quality and cost-efficient health care through DHCS' contracted Medi-Cal MCPs. (Final filing date extended to January 30)
DHCS is also hiring for our communications, human resources, auditing, health policy, information technology, and other teams. For more information, please visit the
CalCareers website.
Upcoming Stakeholder Meetings and Webinars
Population Health Management Updated Transitional Care Services (TCS) Policy Webinar
On January 22, from 11 a.m. to 12 p.m., DHCS will host a
webinar to provide an overview of recent updates to the TCS policy (advance registration required), as outlined in the
Population Health Management Policy Guide. The revised policy clarifies the requirements for high-risk members by updating the definition of “high-risk groups", reaffirming DHCS' focus on maternity care and populations with behavioral health needs, emphasizing MCP oversight on facility discharge planning processes, and underscoring the importance of member engagement.
The TCS policy for lower-risk members was also updated for 2024 and 2025 to provide member-centered transitional care support with a lighter-touch approach than the model for high-risk members. While the updated lower-risk model removes the single point of contact requirement, it does impose a clear but less staff-heavy requirement for a MCP telephonic team to be available for all transitioning members and requires follow-up with a primary or ambulatory care provider within 30 days of discharge. It also emphasizes existing requirements on hospitals regarding the discharge process. The webinar will offer interested stakeholders the opportunity to learn more and ask questions about these recent updates.
Smile, California Campaign for Medi-Cal Dental Services
On January 23, from 11 a.m. to 12 p.m., DHCS' Smile, California campaign will host the
Oral Health Champion webinar to incentivize engagement in the National Children's Dental Health Month (NCDHM) promotion (advance registration required). Participants, including local oral health programs, community-based organizations, California Department of Education partners, school nurses, and other local health leaders, will gain insights on activities that promote the significance of preventive dental care. The focus of the webinar is on fostering the lifelong health of children's and teenagers' teeth and gums through the Medi-Cal Dental Program.
Additionally, on February 1, in recognition of NCDHM, Smile, California will launch a promotion to increase awareness about the significance of routine dental checkups for children and the Medi-Cal Dental Program. The NCDHM promotion emphasizes the importance of preventive dental care and urges parents, guardians, and caregivers to schedule dental check-up appointments for their children.
CalAIM Intermediate Care Facility for the Developmentally Disabled (ICF/DD) Carve-In Office Hours
On January 24, from 11 a.m. to 12 p.m. DHCS will host an office hours session as part of its educational webinar series on the CalAIM intermediate care facility for the developmentally disabled (ICF/DD) carve-in (advance registration required). The office hours will provide a dedicated forum for DHCS and the Department of Development Series (DDS) to engage with ICF/DD Homes, Regional Centers, and Medi-Cal MCP representatives to address questions related to ICF/DD carve-in policy requirements and implementation of the transition to managed care that took effect on January 1, 2024.
Office hours participants are encouraged to submit questions in advance when registering for the session or by emailing them to LTCtransition@dhcs.ca.gov. Additional details about upcoming webinars are available on the CalAIM ICF/DD Long-Term Care Carve-In webpage.
Statewide Home and Community-Based Services (HCBS) Gap Analysis and Multi-Year Roadmap Stakeholder Meeting
On January 24, from 1 p.m. to 2:30 p.m., DHCS and the California Department of Aging (CDA) will host a stakeholder meeting (advance registration required) for the ongoing statewide HCBS Gap Analysis and Multi-Year Roadmap initiatives. Speakers will provide updates and progress reports on the approach to the gap analysis as well as details regarding stakeholder engagement activities and consumer listening sessions underway as part of this work.
For more information about the projects and past meeting materials, please visit the DHCS website and CDA website. If you have any questions, please email HCBSGapAnalysis@dhcs.ca.gov.
Doula Stakeholder Implementation Workgroup Meeting
On January 31, from 2 to 4 p.m., DHCS will host the Doula Stakeholder Implementation Workgroup meeting to examine implementation of the Medi-Cal doula benefit, in accordance with Senate Bill 65 (Chapter 449, Statutes of 2021) and section 14132.24 of the Welfare and Institutions Code.
The meeting will be held via Zoom, with an in-person option at 1700 K Street, Room 1014, Sacramento, CA 95811. The meeting is open to the public. The link to attend the meeting virtually and an agenda will be posted on the Doula Services as a Medi-Cal Benefit webpage. The workgroup will discuss how to ensure doula services are available to Medi-Cal members and make recommendations on outreach efforts. Please email DoulaBenefit@dhcs.ca.gov with any questions.
Launching ECM for Birth Equity Populations: Webinar
On February 2, from 1:30 to 3 p.m., DHCS will host a webinar on Launching ECM for Birth Equity Populations (advance registration required) to review the vision of ECM for the birth equity population of focus (POF) and the early days of implementation. DHCS, in partnership with Medi-Cal MCPs and providers across the state, launched ECM for the birth equity POF on January 1.
This webinar will provide an overview of the design and operational guidance for the birth equity POF; give provider perspectives on how they prepared for the launch of ECM for the birth equity POF and tailored approaches to providing ECM; and offer guidance to MCPs, counties, and providers on contracting and preparing to deliver the ECM benefit to address known disparities in health and birth outcomes in racial and ethnic groups with high maternal morbidity and mortality rates.
The webinar is open to all, but will be of special interest to MCPs and providers working with birth equity populations, including counties and community-based organizations. Providers interested in learning more about ECM for the birth equity POF or about referring members may also attend. Participants are invited to submit questions by January 29 to CalAIMECMILOS@dhcs.ca.gov. Attendees will be able to ask questions during the webinar.
In Case You Missed It
California Invests $70.5 Million in Nonprofits to Improve Equity in Behavioral Health Care
On January 17,
DHCS announced the awarding of $70.5 million to 101 nonprofit entities across the state as part of the Health Equity in Behavioral Health Recovery Services (HEAR US) project. These investments will help expand access to, and use of, behavioral health recovery services among communities of color and other historically marginalized communities.
CalAIM Continuous Coverage for Children Amendment Open for Public Comment
On January 12, DHCS began a 30-day public and tribal public comment period to solicit feedback on a proposed amendment to the CalAIM
Section 1115 demonstration related to
continuous coverage for children. Comments are due by February 12. DHCS is seeking approval from CMS to include expenditure authority under Section 1115(a)(2) to receive federal matching funds to provide continuous coverage for children through the end of the month in which their 5th birthday falls, regardless of when they first enroll in Medi-Cal or the Children's Health Insurance Program or any changes in circumstances that would otherwise cause a loss of eligibility. Additional information about the amendment request and how to submit public comments are available on the
CalAIM 1115 Demonstration and 1915(b) Waiver webpage.
January 2024 Medi-Cal MCP Transition
On January 1, DHCS achieved a significant milestone in its
transformation of Medi-Cal with the launch of the new managed care contract and the
MCP transition, under which approximately 1.2 million members gained new health plan options and/or transitioned to new MCPs (note: changing MCPs does not affect Medi-Cal member coverage or benefits). To facilitate a smooth transition between MCPs for members, DHCS created
Continuity of Care protections to minimize disruptions to members' care.
DHCS developed several resources to support members, providers, and other stakeholders with the transition, including the
MCP Transition Member webpage with a county “lookup" tool, links to the member
notices sent by Medi-Cal about MCP changes,
member frequently asked questions in all threshold languages, and a
Contact Us page for members to learn more about health plan changes. There are also transition resources for
providers,
MCPs, and stakeholders. More information about the transition is available in the
2024 MCP Transition Policy Guide and
Medi-Cal Eligibility Division Information Letter Number I 23-54.
The MCP Transition Member webpage includes resources and information to support members' transition. Members unable to resolve issues or questions after working with their MCP may contact DHCS' Office of the Ombudsman at toll-free (888) 452-8609 or by emailing MMCDOmbudsmanOffice@dhcs.ca.gov.
