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Back to December 2021 Stakeholder Communications Update

California Advancing and Innovating Medi-Cal (CalAIM) Updates

Mandatory Managed Care Enrollment

Mandatory managed care enrollment will standardize enrollment processes to help ensure populations moving between counties are subject to the same requirements, thereby eliminating variances in benefits according to aid code, population, and geographic location. There are two phases to mandatory managed care enrollment:

  • For Phase I, DHCS mailed the first beneficiary notices and a frequently asked questions (FAQ) document in October to impacted beneficiaries regarding their transition into either the managed care or fee-for-service (FFS) delivery system, effective January 1, 2022.
  • For Phase II, DHCS mailed the second beneficiary notices and FAQs in November regarding their transition. DHCS also mailed Medi-Cal Managed Care Choice Packets to beneficiaries eligible for managed care plan (MCP) enrollment at the end of November.

Managed Care Benefit Standardization

Managed care benefit standardization will help ensure consistency in the benefits delivered by managed care and FFS statewide, reducing complexity and county-to-county differences. Under benefit standardization, major organ transplants (currently only a covered benefit in County Organized Health Systems (COHS) counties) will be carved in to Medi-Cal MCPs statewide for all Medi-Cal members enrolled in a MCP, effective January 1, 2022. Additionally, the Multipurpose Senior Services Program (MSSP) will be carved out to FFS and operate as a 1915(c) MSSP waiver benefit in all Coordinated Care Initiative (CCI) demonstration counties, effective January 1, 2022. In November, MCPs in CCI counties mailed beneficiary notices and a Notice of Additional Information document to impacted beneficiaries regarding the carve out of MSSP services.

Dental Initiatives

On September 28, DHCS submitted State Plan Amendment (SPA) 21-0019 to the Centers for Medicare & Medicaid Services (CMS) for federal approval of CalAIM dental initiatives. The SPA is under review; the public comment period ended on September 6. The FFS and safety net clinic (SNC) provider bulletins are published on the Medi-Cal and Medi-Cal Dental websites. Please visit the DHCS website for more information about each CalAIM dental initiative, including required forms and SNC billing requirements.


Medi-Cal COVID-19 Vaccination Incentive Program

DHCS is allocating up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system for the service period of September 1, 2021, through February 28, 2022. Medi-Cal MCPs are eligible to earn incentive payments for activities designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. MCPs may earn up to $50 million for achieving specified process measures and $200 million for outcome measures, with $100 million available for MCPs to use for direct member incentives. Effective September 1, 2021, all 25 full-service MCPs and one population-specific health plan were approved for participation in the program, and DHCS will provide payment allocations for the approved vaccination response plans. DHCS provided baseline data (as of August 29, 2021) to the plans for vaccine uptake outcome measures on October 4, and the MCPs submitted baseline data for their process measures on October 30. The first achievement assessment period ended on October 31. Future achievement assessments will occur in January and March 2022. The high-performance pool component of the incentive program is being developed. For more information, please refer to All Plan Letter 21-010.





Last modified date: 12/10/2021 4:19 PM