December 23, 2024
Top News
CMS Approves MCO Tax Waiver Amendment
On December 20, the federal Centers for Medicare & Medicaid Services (CMS) approved California's Managed Care Organization (MCO) Tax waiver amendment, the final step in allowing DHCS to proceed with implementation. This approval secured an estimated net $7.2 billion through December 2026 in additional funding to support Medi-Cal, as authorized by Senate Bill 160 (Chapter 39, Statutes of 2024). The MCO Tax has provided critical support for Medi-Cal since 2005, evolving through legislative updates to align with California's health care funding needs.
In accordance with state law, DHCS will certify in writing that federal approval has been received and issue notices to each MCO subject to the tax, outlining the amount due for each tax period and the dates on which the installment payments are due. In addition, DHCS will publish on its website information related to the MCO Tax, including the approval letter, tax amounts due for each tax period, and other pertinent information.
California Releases Medi-Cal Managed Care Plan and County Behavioral Health Plan Ratings
Delivering on DHCS' commitment to improve quality and equity in Medi-Cal and behavioral health programs, DHCS announced on December 20 the 2023 managed care plan and county behavioral health plan quality ratings and, in some cases, monetary sanctions for managed care plans that failed to meet or exceed required performance levels. DHCS is dedicated to ensuring Medi-Cal members have access to high-quality, equitable care. To support improvement, DHCS is collaborating with managed care plans and behavioral health plans on performance goals and providing technical assistance to evaluate the effectiveness of quality improvement initiatives.
DHCS posted the Managed Care Accountability Set sanction letters, as required by CMS. These documents highlight managed care plan performance, sanctions, and quality improvement efforts. For questions, contact QualityMonitoring@dhcs.ca.gov. Learn more in the Quality Fact Sheet.
Program Updates
Latest Enhanced Care Management and Community Supports Quarterly Data Released
On December 20, DHCS released the latest Enhanced Care Management (ECM) and Community Supports quarterly report, covering data from January 2022 through June 2024. ECM provides high-touch, team-based care management for Medi-Cal members with complex needs, while Community Supports offer cost-effective, medically appropriate alternatives to traditional services, addressing social drivers of health, such as housing and nutrition. Together, these initiatives are critical to ensuring holistic, person-centered care that improves health outcomes and quality of life for Medi-Cal members. The report demonstrates sustained, quarter-over-quarter growth in both ECM and Community Supports use, as additional Populations of Focus (POF) become eligible for ECM and more services are offered across the state. The report also provides the first data on ECM members in the newly introduced Birth Equity POF and the Individuals Transitioning from Incarceration POF, both of which were launched or expanded in January 2024.
Key findings included 244,750 Medi-Cal members receiving ECM benefits, with 127,024 members served from April through June 2024. This represents a more than 50 percent increase in quarterly ECM members since April through June 2023. About 239,500 members used Community Supports services, and 89 percent of Medi-Cal members had access to at least ten services. This represents a more than 120 percent increase in quarterly Community Supports members since April through June 2023. In April through June 2024, more than 59 percent of members using Community Supports accessed Medically Tailored Meals/Medically Supportive Foods, and approximately 35 percent accessed one or more services from the Housing Trio (Housing Transition Navigation Services, Housing Tenancy and Sustaining Services, and Housing Deposits).
Streamlining Access to ECM
Effective January 1, 2025, managed care plans will be required to implement new ECM Referral Standards and ECM presumptive authorization requirements. DHCS released materials from an October 9 webinar to share details on these two new policies that are intended to make it easier for Medi-Cal members to be referred to and engage in ECM services. In this webinar, DHCS leaders provided:
- An overview of why DHCS reforms that streamline referrals and authorizations for ECM are important for referral partners and members.
- An overview of the ECM Referral Standards, which standardize the set of information all managed care plans will collect on ECM referrals. Entities making referrals to ECM will submit the same information in ECM referrals across counties and managed care plans rather than navigating different requests for referral information.
- An overview of updated requirements for managed care plans to expand the use of ECM streamlined presumptive authorization so more ECM providers can start serving members right away. Select categories of ECM providers already contracted in a managed care plan's ECM provider network will be able to initiate ECM for members and be paid for ECM services during a 30-day timeframe while waiting for a managed care plan's authorization decision.
Materials from the webinar are available on the
ECM and Community Supports website.
Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 4 Application
On January 6, 2025, DHCS will open the PATH CITED Round 4 application window. 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. The deadline to apply for CITED Round 4 funding is 11:59 p.m. PST on March 7, 2025. Interested organizations are encouraged to access the application outline and guidance document to help prepare their application. Please submit questions to cited@ca-path.com.
Long-Term Services and Supports (LTSS) Data Dashboard
On December 27, DHCS will release a refreshed version of the interactive LTSS Data Dashboard, improving data transparency and accessibility. The dashboard reports utilization and demographic data by counties and managed care plans and explores trends across quality measures, services, and subpopulations throughout California. This information will be used to improve quality and health equity for Medi-Cal members accessing LTSS. In this newest version of the LTSS dashboard, the user interface allows for multiple data visualization techniques. The data are available at the statewide level, with the ability to filter by age group, delivery system, dual eligibility status, primary language, race, ethnicity, and sex. New measures related to cost, length of stay, and quality are included in this update. The rich visualization of data within the dashboard illustrates DHCS' ongoing progress toward transparency of LTSS utilization from institutional care to home- and community-based services.
Smile Into 2025: New Campaign and Resources for Medi-Cal Members
As the new year approaches, Smile California is helping Medi-Cal members start 2025 with healthier smiles. Recent Facebook and Instagram Smile Alerts highlight the importance of establishing a dental home for regular check-ups and early detection of potential dental issues. This campaign aims to encourage members to explore their dental benefits, refresh their at-home care routines, and find the perfect dentist.
Join Our Team
DHCS is seeking a talented and motivated individual to serve as:
- Chief of the Managed Care Quality and Monitoring Division to lead compliance-related activities for the state's Medi-Cal managed care plans. These activities include, but are not limited to, developing and implementing policies, establishing standard operating procedures, engaging in continual improvement efforts, providing technical assistance, and conducting risk analysis for managed care plan audit programs in partnership with DHCS' Contract and Enrollment Review Division. Applications must be submitted by December 26.
DHCS is also hiring for its health policy, information technology, and other teams. For more information, please visit the CalCareers website.
Upcoming Stakeholder Meetings and Webinars
California Children's Services (CCS) Advisory Group Meeting
On January 8, 2025, DHCS will host the quarterly CCS Advisory Group quarterly meeting. DHCS and the CCS Advisory Group partner to ensure children in the CCS/Whole Child Model (WCM) program receive appropriate and timely access to quality care. Agenda topics include a recap of the CCS 2024 priorities, a look ahead to 2025, and updates on the WCM expansion, ECM, Medi-Cal Rx, and the CCS Redesign Performance Measure Quality Subcommittee. Additional information and meeting details are available on the CCS Advisory Group webpage.
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 best practices to incorporate the tenets of harm reduction into substance use disorder treatment. Summits will be held in Fresno County (January 23, 2025), San Diego County (February 11, 2025), and Los Angeles County (February 27, 2025). Register on the event website.
Coverage Ambassador Webinar Series: Justice-Involved Reentry Initiative and Children and Youth Behavioral Health InitiativeUpdate
On January 30, 2025, from 11 to 11:45 a.m. PST, DHCS will host a Justice-Involved Reentry Initiative and Children Youth Behavioral Health Initiative (CYBHI) update (advanced registration required) as part of the Coverage Ambassador webinar series. This session will provide detailed 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. The session will also 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.
In Case You Missed It
CMS Approved California's BH-CONNECT Initiative to Transform Behavioral Health Services
CMS approved the California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration. This transformative initiative will expand access to essential behavioral health services for Medi-Cal members with significant mental health and substance use needs. It combines federal, state, and local investments to create a more robust, equitable behavioral health system that prioritizes community-based solutions. By reducing emergency department visits and institutional stays, BH-CONNECT will help Californians achieve stability and recovery while building a stronger behavioral health workforce and service delivery system.
DHCS Awards $65 Million to Community-Based and Tribal Organizations for Youth Substance Use Prevention
On December 19, DHCS awarded nearly $65.5 million in grant funding to 95 youth-serving community-based and Tribal organizations to expand substance use disorder prevention programs. Organizations will receive total awards for grants up to $1 million for the three-year grant period to implement the Elevate Youth California program in low-income, under-resourced communities and communities of color. These grants will support young Californians statewide in staying healthy by educating them about the risks of substance use disorders and how to prevent them.
DHCS Awards $19.3 Million to Enhance Opioid Treatment
On December 17, DHCS awarded more than $19 million to 25 organizations to support low-barrier opioid treatment at syringe services programs (SSP) from September 30, 2024, through September 29, 2027. Awardees include SSPs providing or supporting health care services in California, such as assessment, prescription, and management of medication for the treatment of opioid use disorder. This project expands existing SSP services available in California communities and supports the integration of opioid use disorder treatment services and other harm reduction services into existing sites. This increases the number of patients receiving support and reduces or eliminates obstacles to accessing, initiating, and continuing opioid use disorder treatment.
