​November 19, 2024

Program Updates​

Medi-Cal Birth Statistics

DHCS recently posted the 2007-2022 Medi-Cal Birth Statistics on the Open Data Portal. These machine-readable files are designed to be user-friendly and promote seamless access to better inform the public, stakeholders, and researchers. The data provide extensive information about births and birth outcomes for Medi-Cal members using data from the California Department of Public Health vital records and Medi-Cal eligibility information.

The files present summarized tables of California resident births that occurred in a hospital setting, including maternal demographics, such as age, delivery methods, and select birth outcomes, including low birthweight and preterm delivery. The tables also include key comorbidities and health behaviors known to influence birth outcomes, such as pre-pregnancy weight and smoking during pregnancy. Additionally, DHCS presents births financed by private insurance, births financed by other public funding sources, and births among uninsured mothers.

Medi-Cal is a significant payer source of California maternal and infant health care services. In 2022, the Medi-Cal program financed 44.6 percent of all in-hospital California resident births. Of the 183,844 births financed by Medi-Cal, 78.2 percent were to mothers participating in managed care.

New CalAIM Resources for Medi-Cal Providers

On November 12, DHCS launched a series of new resources to help providers succeed in California Advancing and Innovating Medi-Cal (CalAIM) opportunities. The resources are available in the Providing Access and Transforming Health (PATH) On-Demand Resource Library and include Medi-Cal Managed Care 101 for Community Supports Providers, Medi-Cal Managed Care 101 for Enhanced Care Management (ECM) Providers, and a CalAIM Navigator video series.

The resources are designed to help organizations contracted with or planning to contract with Medi-Cal managed care plans to provide ECM and/or Community Supports services. Please submit questions to ta-marketplace@ca-path.com.

2023 Annual Network Certification (ANC)

On October 31, DHCS submitted the 2023 ANC to the federal Centers for Medicare & Medicaid Services (CMS), inclusive of Medi-Cal managed care plan and behavioral health plan networks. The 2023 ANC was originally due to CMS on June 28, 2024, but DHCS requested an extension because DHCS operationalized enhancements to its monitoring processes that resulted in a significant increase in the volume of Medi-Cal managed care plan alternative access standard requests (AAS) and a delay in county data reporting and incomplete data submissions for behavioral health plans.

For Medi-Cal managed care plans, the increased AAS volume does not indicate a change in member access to care and is a direct result of DHCS strengthening the system platform and methodology for measuring compliance with time or distance standards, in collaboration and alignment with the Department of Managed Health Care. The new system platform and methodology strengthen DHCS' ability to monitor member access to care, better reflect the member experience, and apply a consistent approach across all populations, enabling DHCS to target resources to areas with true gaps in access. Several Medi-Cal managed care plans did not meet AAS submission requirements and are required to complete a Corrective Action Plan (CAP) detailing the actions they will immediately implement to ensure compliance.

The delays and incomplete BHP data are a direct result of improvements DHCS made to the timely access data reporting methodology to strengthen DHCS' ability to monitor member access to behavioral health care. For the behavioral health plan network reviews, several Drug Medi-Cal Organized Delivery System (DMC-ODS) plans and county mental health plans did not meet one or more network adequacy standards and are required to submit and complete a CAP to DHCS detailing the actions they will immediately take to demonstrate compliance.

Given the significant changes to the AAS system for Medi-Cal managed care plans and the data reporting requirements for behavioral health plans, many plans submitted incorrect and/or incomplete data as part of the ANC reviews. DHCS estimates many of the CAPs will be resolved through addressing data reporting issues and are not indicative of noncompliance with network adequacy standards.

By November 29, DHCS will post the ANC results for Medi-Cal managed care plan and behavioral health plan networks on the Network Adequacy webpage. These results will also include the Subcontractor Network Certification (SNC) for Medi-Cal managed care plan networks. Medi-Cal managed care plans are required to undergo a SNC annually that is separate and distinct from the ANC submission process. Under the SNC, Medi-Cal managed care plans must hold their subcontractors and downstream subcontractors to the same network adequacy components DHCS requires of Medi-Cal managed care plans through the ANC (i.e., time or distance, timely access, provider-to-member ratio, and mandatory provider-type contracting requirements). All managed care plans met the SNC submission requirements as required by All Plan Letter 23-006.

Additionally, DHCS is implementing strategies to monitor and improve access to care for Medi-Cal members. These strategies focus on aligning access standards across managed care delivery systems, identifying gaps in access to care and formulating strategies to eliminate those gaps over time, and developing enhanced tools for ongoing access monitoring.

Join Our Team

DHCS is seeking a talented and motivated individual to serve as the Chief of the Contract and Enrollment Division (CERD) within Audits and Investigations. The Chief is responsible for planning, organizing, and directing the activities for compliance reviews of health plans, providers, and Drug Medi-Cal Organized Delivery Systems. The Chief also leads the development and implementation of policies and procedures related to program integrity of Medi-Cal and other DHCS programs. Applications must be submitted by December 6, 2024.