​​​​​Program Updates

Back to February 2022 Stakeholder Communications Update

Assisted Living Waiver (ALW) Slot Expansion

On January 7, CMS approved DHCS' amendment to the ALW to add 7,000 slots to eliminate the current waitlist and expand waiver capacity. This amendment is retroactive to July 1, 2021. The purpose of the ALW is to keep eligible seniors and persons with disabilities in their communities and out of institutional care settings.

On July 12, 2021, DHCS submitted Medi-Cal's Home and Community-Based Services (HCBS) Spending Plan, authorized by Section 9817 of the American Rescue Plan Act (ARPA). ARPA includes an additional 10 percent Federal Medical Assistance Percentage (FMAP) on certain HCBS services, which can then be reinvested to expand and improve HCBS. CMS conditionally approved California's HCBS Spending Plan on January 4, 2022. DHCS intends to fund the ALW slot expansion through the enhanced FMAP available through ARPA.

Behavioral Health Continuum Infrastructure Program (BHCIP) Update

On January 10,  DHCS released the “BHCIP Round 2B: Planning Grant – Request for Application (RFA)" to solicit applications from county behavioral health agencies and tribal entities for DHCS' BHCIP and the California Department of Social Services' (CDSS) Community Care Expansion (CCE) program. DHCS and CDSS re-released this non-competitive joint RFA for eligible organizations to receive up to $150,000 each to initiate and support planning efforts, from April 2022 through December 2022, for the acquisition and expansion of behavioral health infrastructure throughout the state. DHCS and CDSS released the initial RFA from November 1-30, 2021, and on January 3 awarded a total of $5,351,756 to 36 entities (nine are tribes). The BHCIP Round 2B: Planning Grant RFA deadline is February 28, 2022.  

On January 31, DHCS, in partnership with CDSS, released the BHCIP: Round 3 Launch Ready and CDSS Community Care Expansion Program joint RFA. Eligible organizations for BHCIP Round 3: Launch Ready may apply and receive funding support to construct, acquire, and rehabilitate real estate assets in settings that serve Medi-Cal beneficiaries. For BHCIP, applications will only be accepted from projects that are determined to have been through a planning process, are ready for implementation, and will expand the behavioral health continuum. DHCS will award up to $518.5 million in grant funds for BHCIP Round 3: Launch Ready, and funding must be obligated by June 2024 and liquidated by December 2026. 

BHCIP Round 3: Launch Ready will be composed of two application parts to balance the needs of projects capable of immediate expansion with applicants that require more time to develop their application. This will offer applicants two potential deadlines for submissions. Any remaining funds not awarded in Part One will be available for Part Two applicants. The deadline is March 31, 2022, for all Part One applications and May 31, 2022, for Part Two applications.

DHCS was authorized through 2021 legislation to establish BHCIP and award $2.1 billion to construct, acquire, and expand properties and invest in mobile crisis infrastructure related to behavioral health. CDSS oversees CCE, which was established through Assembly Bill (AB) 172 (Chapter 20, Statutes of 2021) as a companion effort, totaling $805 million, and focused on the acquisition, construction, and rehabilitation of adult and senior care facilities that serve Supplemental Security Income/State Supplementary Payment and Cash Assistance Program for Immigrants applicants and recipients and other adults who are experiencing or at risk of homelessness.

For more information, please email BHCIP@dhcs.ca.gov or visit the BHCIP project website.

Behavioral Health Federal Grants Update

On December 27, 2021, DHCS released a RFA that closed on January 28, 2022, for $11 million to public and private non-profit organizations to implement the Opioid Use and Stimulant Use Prevention and Recovery Services in the LGBTQ2S+ Community Project from March 1, 2022, through February 28, 2023. Eligible entities were able to apply for up to $250,000 each to support prevention and recovery services targeting opioid and stimulant use specifically within the LGBTQ2S+ community throughout California. Eligible activities include: training and funding substance use navigators, behavioral health counselors, promotoras, cultural brokers, community ch​ampions, peer workers, and others to incorporate opioid use and stimulant use outreach, prevention, and treatment referrals into their workflow; implementing a stigma-reduction campaign; developing and disseminating educational prevention materials; incorporating trauma-informed education and outreach; and recovery services.

This initiative is funded by the State Opioid Response 2 grant and the Coronavirus Response and Relief Supplemental Appropriations Act, awarded by the federal Substance Abuse and Mental Health Services Administration, and is administered by Sierra Health Foundation: Center for Health Program Management as the administrative entity on behalf of DHCS. For more information about this funding opportunity, please email DHCSMATExpansion@dhcs.ca.gov or visit the DHCS website.

CalHealthCares Loan Repayment Program

The Budget Act of 2018 appropriated $220 million from Proposition 56 to DHCS. Senate Bill (SB) 849 (Chapter 47, Statutes of 2018) established the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program (LRP) (commonly referred to as CalHealthCares). The Budget Act of 2019 appropriated an additional $120 million from Proposition 56 to DHCS for a total of $340 million to be administered over five cohorts. Eligible physicians may apply for a loan repayment up to $300,000 in exchange for a five-year service obligation. Eligible dentists may apply for either a loan repayment up to $300,000 in exchange for a five-year service obligation or a practice support grant up to $300,000 in exchange for a ten-year service obligation.

The Fiscal Year (FY) 2021-22 Cohort 4 application cycle for CalHealthCares opened on January 24 and will close on February 25. Approximately $54 million is available for physicians and $9 million for dentists who are committed to seeing Medi-Cal patients in California over five years. Please visit CalHealthCares.org for specific eligibility requirements, application information, and informational webinar dates.

CalHOPE

CalHOPE continues to provide emotional support services to hard-to-reach populations throughout California. In December 2021, CalHOPE and Media Solutions launched a new flight of CalHOPE posters in convenience stores and American Legion and Veterans of Foreign Wars locations. In addition, Media Solutions launched a special holiday-themed CalHOPE creative for digital display, social, radio, and print, collectively delivering 59,000 media spots.

In January 2022, All It Takes, in partnership with CalHOPE and the California Department of Education, launched A Trusted Space, a film-based program aimed at training educators to help mitigate the effects of emotional stressors on students and their families. This program will be provided to all California public middle and high schools during the 2021-2022 academic year. Lastly, CalHOPE collaborated with the NBA's Sacramento Kings to provide messaging outside and inside of Golden 1 Center during their game against the Cleveland Cavaliers on January 10.

As uncertainty continues over COVID-19, in January, CalHOPE submitted a 30-day extension to the federal government and received approval to extend the program to March 11. CalHOPE also submitted an additional 60-day extension request to provide crisis counseling services and emotional support through spring 2022.

Continuous Glucose Monitors

DHCS added Therapeutic Continuous Glucose Monitoring Systems as a pharmacy-billed medical supply benefit through Medi-Cal Rx, effective January 1. The coverage criteria and provider bulletins are available on the Medi-Cal Rx website.

Dementia Aware Initiative and SB 48

As part of the HCBS Spending Plan, DHCS is developing the Dementia Aware initiative that will leverage $25 million in one-time enhanced federal funding to establish a statewide provider training program in culturally competent dementia care as well as a referral protocol on cognitive health and dementia for Medi-Cal beneficiaries. This is consistent with the standards for detecting cognitive impairment under Medicare and the recommendations by the American Academy of Neurology, the California Department of Public Health's (CDPH's) Alzheimer's Disease Program, and CDPH's ten California Alzheimer's Disease Centers (CADC).

Aligned with this initiative, SB 48 (Chapter 484, Statutes of 2021), establishes an annual cognitive health assessment as a Medi-Cal-covered benefit, available to Medi‑Cal‑only beneficiaries who are 65 years of age or older and otherwise ineligible for a similar assessment under Medicare. SB 48 makes a Medi-Cal provider eligible to receive payment for this benefit only if the provider completes cognitive health assessment training as specified by DHCS. The target implementation date for this benefit is July 1, 2022.

DHCS met with CDPH's Alzheimer's Disease Program, the CADCs, the Alzheimer's Association, the California Academy of Family Physicians, the California Health & Human Services Agency Alzheimer's Disease and Related Disorders Advisory Committee, and other stakeholders during the last quarter of 2021 to further establish the needs of the provider training program and to collect clinical and training resources to review and potentially incorporate into the initiative. In collaboration with a University of California (UC) contractor, DHCS will review resources and develop an online provider training. DHCS issued a Request for Information to potential UC collaborators, with the goal of executing a contract in March. DHCS will continue to solicit feedback from stakeholders as the initiative unfolds.

Dental Transformation Initiative (DTI)

As of December 31, 2021, Domain 2 payments issued total approximately $228 million, and 3,512 providers have opted in to participate. The goal of Domain 2 is to diagnose early childhood caries by using caries risk assessments to treat it as a chronic disease and to introduce a model that prevents and mitigates oral disease. In accordance with the Medi-Cal 2020 waiver extension, DTI concluded on December 31, 2021. For more information, please visit the DHCS website.

Full-Scope Pregnancy 

On December 16, 2021, CMS approved SPA 21-0066 to provide full-scope Medicaid coverage to all beneficiaries in the Medicaid pregnancy eligibility group with incomes up to and including 213 percent of the federal poverty level, effective January 1. The targeted population for this policy is citizens and lawfully residing individuals. DHCS will issue an All County Welfare Directors Letter to notify partners, publish provider bulletins and newsflashes, and update the DHCS pregnancy webpage. 

Medi-Cal Health Enrollment Navigators Project

Due to the community health impacts of COVID-19, health enrollment navigator services are now more critical than ever. Under AB 74 (Chapter 23, Statutes of 2019), $59.7 million was appropriated to DHCS to partner with counties and community-based organizations (CBOs) to conduct Medi-Cal outreach, enrollment, retention, and navigation services for hard-to-reach Medi-Cal and potentially eligible Medi-Cal populations. Project partners have implemented innovative and creative approaches to contact and enroll eligible populations in their local communities, provided vaccine information and outreach at the local level, and engaged college students at all levels. The current phase of the project allows CBOs and counties to incorporate new or expand existing activities for all participants, and continue adjusting their outreach and enrollment approaches to overcome challenges presented by COVID-19. As of January 2022, five project partners have released unspent funds, which are being reallocated to existing partners at the earliest possible date. Information and updates related to the project are available on the DHCS website.

Medication Therapy Management (MTM)

MTM services are now a Medi-Cal be​nefit for pharmacists. MTM pharmacy services may be billed by a Medi-Cal enrolled pharmacy with an approved Medi-Cal Specialty Pharmacy Provider Application (MC 3155), as well as a signed supplemental services agreement with DHCS for MTM services. Providers may refer to part 2 of the Provider Manual for a detailed explanation of MTM benefits. Providers wishing to receive a copy of the contract must send their requests to MTMquestions@dhcs.ca.gov.

MTM pharmacy services are benefits for eligible Medi-Cal beneficiaries who meet certain qualifying conditions (refer to part 2 of the Provider Manual for a full list). In addition, the Medi-Cal beneficiary must be using a drug (or drugs) for the treatment of a diagnostic condition (refer to part 2 of the provider manual for a full list). Initially, DHCS will contract for MTM services related to: 

• HIV/AIDS 
• Serious mental health conditions (psychotic disorders, such as schizophrenia/schizoaffective disorder, bipolar disorder, etc.) 
• Cancer 
• Hemophilia 
• Diabetes 

Additional conditions will be added on a flow basis in the coming months. MTM pharmacy services are carved out of Medi-Cal managed care. Questions related to the supplemental agreement, contracting process, or MTM services may be submitted to MTMquestions@dhcs.ca.gov.

Multipurpose Senior Services Program (MSSP) Waiver Amendment

On November 19, 2021, DHCS submitted an amendment to CMS to carve out the MSSP program from the 1115 Bridge to Reform demonstration and amend the 1915(c) waiver. On October 1, DHCS, in collaboration with the California Department of Aging, posted the waiver amendment for a 30-day public comment period. The amendment to the 1915(c) waiver will revert all Coordinated Care Initiative counties (except San Mateo County) back into the MSSP waiver fee-for-service delivery system. Additional changes to the waiver include an update to the geographic service area of counties already being served, anticipated Electronic Visit Verification implementation, and the addition of participant slots. DHCS is awaiting final CMS approval of the waiver amendment.

The MSSP waiver provides social and health care management for frail, elderly clients who qualify for placement in a nursing facility, but who wish to remain in the community. The goal of the MSSP is to avoid the premature placement of persons in nursing facilities, while fostering independent living in the community.

Public Hearing Regarding Designation of Categorical Risk Levels for Drug Medi-Cal providers

On February 24, DHCS is holding a virtual public hearing to discuss changes to the designation of categorical risk levels for Drug Medi-Cal applicants. In accordance with CMS' newly designated categorical risk levels for newly enrolling and revalidating opioid treatment programs, DHCS is issuing a provider bulletin to update the designation of categorical risk levels for Drug Medi-Cal applicants with Narcotic Treatment Program or Heroin Detoxification Program services modalities. Stakeholders will have the opportunity to submit questions and suggestions during the hearing; written comments will be accepted on the day of the hearing until 5 p.m. After reviewing the public comments received, DHCS will publish the final bulletin on the Medi-Cal and DHCS websites. The changes will become effective 30 days after publication.

Smile, California Campaign for Medi-Cal Dental Services

In November 2021, Smile, California hosted two virtual member presentations on Facebook Live in English and Spanish. These presentations outlined dental services for all age groups that are covered by Medi-Cal and highlighted common questions regarding benefits and coverage. The presentations received 228 total combined views. 

Also in November, a Smile, California outreach representative participated in a live radio segment. The segment was translated into Mixteco, an indigenous language spoken by tens of thousands of California migrants. The interview was broadcast throughout Ventura County. The interview received more than 10,000 radio impressions. The outreach representative discussed the Medi-Cal Dental Program, the program's covered services, the importance of regular dental visits, and how to find a Medi-Cal dentist. 

In December, the social media gallery on SmileCalifornia.org was updated with five new social media images and suggested captions for partners and providers to post to their social media accounts featuring the following topics:  

• Pain awareness 
• Molar sealants 
• Caring for loved ones' oral health 
• Medi-Cal dental benefits 
• The importance of dental check-ups for children 

Smile, California is supporting National Children's Dental Health Month (NCDHM) in February. Two virtual informational webinars were held on January 19 and 20 to empower local health champions statewide to motivate Medi-Cal enrolled and eligible members in their communities to learn about the Medi-Cal Dental Program and schedule dental appointments for themselves and their children. The webinars were recorded and posted on SmileCalifornia.org under “Partners and Providers."

Also, a new webpage dedicated to NCDHM is published on SmileCalifornia.org and SonrieCalifornia.org, which feature educational resources about children's oral health, activity sheets, and a new dental health superhero coloring sheet available for download​