​DHCS Stakeholder News - July 21, 2023​​

Top News

Medi-Cal Renewals Update

On July 20, DHCS previewed the topline, preliminary Medi-Cal renewal data for June 2023, the first month of California's redeterminations since the end of the federal continuous coverage requirement. More than 81 percent of the 1,052,030 Medi-Cal members eligible for renewal in June returned their packet to county offices for review or completed their renewals through ex parte. On July 1, California disenrolled approximately 225,000 Medi-Cal members for the month of June, a 21 percent disenrollment rate.

Prior to the COVID-19 continuous coverage requirement, California would typically see a disenrollment rate of between 18-20 percent. However, that was after the 90-day cure period (when members who are disenrolled can return the necessary information to reinstate their coverage back to their original renewal date), which for the June disenrollments will be at the end of September. Historically, California has seen a reinstatement rate of approximately 4 percent over the 90-day cure period; therefore, California is projecting a disenrollment rate of closer to 17 percent after the cure period. DHCS will report final June disenrollment rates in October.

If a member's eligibility renewal date was in June, it's not too late. They have until the end of September to return their Medi-Cal renewal packet to the local county office to get their coverage reinstated back to their original renewal date. If members receive a Medi-Cal renewal packet in the mail in a yellow envelope, they must act quickly to keep themselves and their families covered by returning renewal documents. DHCS is committed to working with Medi-Cal members in this effort and appreciates that we have thousands of partners helping us to conduct multilingual, culturally appropriate outreach to members.

Medi-Cal Targeted Provider Rate Increases

Pursuant to the Budget Act of 2023 and Assembly Bill (AB) 118 (Chapter 42, Statutes of 2023), DHCS is developing targeted provider rate increases for primary care, obstetric, and non-specialty mental health services, effective on or after January 1, 2024, in the Medi-Cal fee-for-service (FFS) and managed care delivery systems.

These investments will support DHCS' Comprehensive Quality Strategy and its clinical focus on children's preventive care, maternal care and birth equity, and behavioral health integration—aligning our efforts toward upstream preventive and primary care interventions. DHCS published the proposed procedure code list and additional information on the DHCS website. Additional information, including a public notice of the upcoming State Plan Amendment (SPA), will be published on the DHCS website in the coming weeks.

Program Updates

Approval of Community-Based Mobile Crisis Intervention SPA

On July 20, the Centers for Medicare & Medicaid Services (CMS) approved SPA 22-0043, which adds community-based mobile crisis intervention services to California's Medicaid State Plan as a reimbursable benefit effective January 1, 2023. All 58 counties will implement the benefit, resulting in mobile crisis services available 24 hours a day, 7 days a week, 365 days a year. Mobile crisis intervention services provide relief to members experiencing a behavioral health crisis, expanding related efforts supporting the crisis continuum of care, such as the 988 Suicide and Crisis Lifeline, which provides 24/7 one-on-one support, crisis intervention and de-escalation, and information and referrals to linked callers to appropriate community resources in their city or county. For more information, please read CMS' press release.

Behavioral Health Payment Reform SPA

On July 20, CMS approved SPA 23-015, CalAIM's Behavioral Health Payment Reform initiative, effective July 1, 2023, allowing DHCS to transition counties from cost-based reimbursement funded via Certified Public Expenditures to FFS reimbursement funded via Intergovernmental Transfers to eliminate the need for reconciliation to actual costs. The implementation of this initiative will allow DHCS to improve reporting and support data-driven decision-making by disaggregating data on specialty behavioral health services and comply with CMS requirements to adopt Current Procedural Terminology in lieu of the broader Healthcare Common Procedure Coding System.

DHCS detailed more than 10 unique rate methodologies resulting in more than 40,000 new and distinct rates, which will be paid to counties for specialty mental health services and substance use disorder (SUD) services on a FFS basis. This approval comes at the end of a four-year development and collaboration process with the California Behavioral Health Directors Association and provider stakeholders to relieve counties and providers of the administrative burdens of cost reconciliation financing.

Equity and Practice Transformation Payments Program

DHCS is implementing a one-time $700 million provider practice transformation program ($350 million General Fund) to advance health equity and reduce COVID-19-driven care disparities. The initiative will invest in upstream care models and partnerships to address health and wellness and transform funding practices to allow Medi-Cal providers to better serve the state's diverse Medi-Cal members.  

These competitive grants will be awarded in a phased approach. The first phase of the program is the Medi-Cal Managed Care Plan (MCP) Initial Provider Planning Incentive Payments Program ($25 million), which will allow MCPs to identify and work with small- to medium-sized independent practices using standardized assessment tools to support those practices as they develop practice transformation plans and applications.  

For more information, please see Equity and Practice Transformation Payments Program webpage.

APPLICATION DUE DATE EXTENDED: Care Economy Payments for Home and Community-Based Services (HCBS) Direct Care Workers

On June 12, DHCS opened the application for the Care Economy Payment for HCBS Direct Care Workers. On July 10, DHCS extended the filing deadline to July 28, 2023. DHCS encourages early application submission to allow ample time for validation and processing before the extended due date. DHCS anticipates issuing payments to approved provider organizations in November 2023, and applicants receiving funding must issue payments to qualified employees within 60 days of receipt of funds. To access the application and supporting guidance, please visit the Care Economy Payments for HCBS Direct Care Workers webpage. Additional questions can be submitted to HCBSCareEconomyPayments@dhcs.ca.gov.

Join Our Team 

DHCS is hiring! DHCS has an immediate opening for Chief, Program Data Reporting Division, within Enterprise Data and Information Management. This executive role serves as the principal policymaker and advisor in support of comprehensive data analytics and reporting activities.

DHCS is also hiring for our fiscal, human resources, legal, auditing, health policy, and information technology teams. For more information, please visit the CalCareers website.  

DHCS is dedicated to preserving and improving the overall health and well-being of all Californians. DHCS' mission is to provide the most vulnerable residents with equitable access to affordable, integrated, high-quality health care, and is currently transforming the Medi-Cal program to make sure it provides the care Californians need to live healthier, happier lives. 

Upcoming Stakeholder Meetings and Webinars

Smile, California Campaign for Medi-Cal Dental Services