March 24, 2025
Top News
California Submits Application to Expand Sickle Cell Disease Treatment
On March 11, DHCS
applied to CMS to participate in the groundbreaking Cell and Gene Therapy (CGT) Access Model. If accepted, DHCS will implement this multi-year initiative to expand Medi-Cal members' access to innovative and potentially life-changing therapies for sickle cell disease (SCD), a severe genetic blood disorder that disproportionately impacts people of African descent. Gene therapy represents a groundbreaking approach to SCD. However, these therapies come with extraordinary costs, making access difficult for patients and Medicaid programs, including Medi-Cal. The CGT Access Model addresses this challenge by using a negotiated rebate system that ties payments for these treatments to patient outcomes. If the therapy does not meet expected health improvements, drug manufacturers will provide rebates to Medicaid programs, helping ensure financial sustainability while expanding access to care. If California is approved, eligible Medi-Cal members would gain access to gene therapy treatment, fertility preservation services, case management, travel assistance, and behavioral health support. CMS anticipates testing the model over an 11-year performance period. If approved, California will begin participating in this model on July 1, 2025.
Traditional Health Care Practices Benefit Implementation
On March 21, DHCS published
Behavioral Health Information Notice (BHIN) 25-007 – Traditional Health Care Practices Benefit Implementation. This policy, the result of years of dedicated effort and advocacy from California Tribal leaders and partners, provides guidance on the implementation of the traditional health care practices benefit in the Drug Med-Cal Organized Delivery System (DMC-ODS). The federal Centers for Medicare & Medicaid Services (CMS) approved DHCS to cover traditional health care practices provided by Indian Health Care Providers (IHCP) for Medi-Cal members in DMC-ODS counties through December 31, 2026, unless extended or amended. Traditional health care practices encompass two new service types: Traditional Healer and Natural Helper services. DMC-ODS counties will cover Traditional Healer and Natural Helper services provided by IHCPs to Medi-Cal members who meet DMC-ODS access criteria. For questions about traditional health care practices or this BHIN, please email
traditionalhealing@dhcs.ca.gov.
Additionally, on April 22, DHCS will present an overview of BHIN 25-007 at the
Tribes and Indian Health Program Representatives meeting (advance registration required). The presentation is open to the public and will review policy guidance to support IHCPs and DMC-ODS counties in implementing this new benefit. Attendees are encouraged to submit questions in advance to
traditionalhealing@dhcs.ca.gov with the subject line “Traditional Health Care Practices Implementation."
Program Updates
Now Available: Webinar Materials on Closed-Loop Referral Implementation Guidance
Effective July 1, 2025, Medi-Cal managed care plans will be required to implement
Closed-Loop Referral (CLR) requirements for
Enhanced Care Management (ECM) and Community Supports. CLR requirements aim to increase the number of Medi-Cal members successfully connected to these benefits and services. By improving information collection processes, managed care plans will be able to better support individual referrals and address system-level gaps in referral practices and service availability that impact members. DHCS
released materials from the February 13 webinar (posted under Informational Webinars) to share more details about these requirements. In the webinar, DHCS provided:
- The Department's goal and motivation for releasing new CLR requirements.
- How CLR requirements will improve the member referral process by streamlining referral tracking, supporting, and monitoring efforts.
- An example use-case scenario on how CLR requirements would assist a member in receiving the Medically Tailored Meals Community Support.
Contact DHCS with any questions or comments about California Advancing and Innovating Medi-Cal (CalAIM) Population Health Management initiatives at
PHMSection@dhcs.ca.gov.
Join Our Team
DHCS is hiring for its financial, human resources, pharmacy, behavioral health, and other teams. For more information, please visit the
CalCareers website.
Upcoming Stakeholder Meetings and Webinars
DHCS posts upcoming public meetings on the
Calendar of Events.
Coverage Ambassador Webinar
On March 25, from 11 a.m. to 12 p.m. PDT, DHCS will host a Coverage Ambassador webinar (
advance registration required) to provide information about health care options and updates to Medi-Cal. Coverage Ambassadors help spread the word about Medi-Cal benefits, enrollment information, and new projects focused on creating a healthy California for all. Please visit the
Coverage Ambassador website for more information, or
subscribe to become a Coverage Ambassador and receive regular updates.
Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup meeting
On March 27, from 10 a.m. to 12 p.m. PDT, DHCS will host the CalAIM
MLTSS and Duals Integration Workgroup meeting (advance registration required). The workgroup is a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible members. It allows stakeholders to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medi-Cal and Medicare. The meeting agenda includes updates on Medicare enrollment data for dual eligible members, the Dual Eligible Special Needs Plan (D-SNP) Dashboard, D-SNP initiatives, and the D-SNP State Medicaid Agency Contract and Policy Guide. It also includes data updates on Enhanced Care Management and Community Supports for dual eligibles and a Community Supports service spotlight presentation on
select service definition updates.
More information, background materials, transcripts, and video recordings of previous workgroup meetings are posted on the
CalAIM MLTSS and Duals Integration Workgroup webpage. For questions or comments, please email DHCS at
info@calduals.org.
Hearing Aid Coverage for Children Program (HACCP) Webinar for Medical Providers and Hearing Professionals
On March 27, from 12 to 1 p.m. PDT, DHCS will host the quarterly HACCP webinar for medical providers and hearing professionals. For more information and to
register, please visit DHCS'
HACCP webpage. Registration information will be posted as the webinar date approaches.
In Case You Missed It
Now Open: Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 4 Application
On January 6, DHCS opened the
PATH CITED Round 4 application window, which includes funding opportunities to support the implementation of the new transitional rent Community Support. The PATH CITED initiative provides funding to build the capacity and infrastructure of on-the-ground partners, including community-based organizations, hospitals, county agencies, Tribes, and others, to successfully participate in Medi-Cal. All organizations providing the transitional rent Community Support must do so in partnership with their county behavioral health department. To demonstrate this partnership, all CITED applicants planning to request funding to support the transitional rent Community Support must also submit a
Letter of Support in collaboration with the county behavioral health department.
The deadline to apply for PATH CITED Round 4 funding is 11:59 p.m. PDT on May 2, 2025. The guidance document and application are available on the PATH CITED webpage. Please send any questions to cited@ca-path.com.
