XOV XWM TSHIAB​​ 

Kev Hloov Pauv Medi-Cal ntawm California Txuas Ntxiv Mus​​ 

Cov ntaub ntawv tshiab qhia ntau lub nroog tab tom ua kom zoo dua kev tswj hwm kev saib xyuas thiab kev txhawb nqa hauv zej zog, pab ntau tus neeg California tau txais kev saib xyuas lawv xav tau​​ 

SACRAMENTO — Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) hnub no tau tshaj tawm qhov hloov tshiab txhua peb lub hlis txog cov ntaub ntawv tshiab tshaj plaws ntawm Enhanced Care Management (ECM) thiab Community Supports . Cov ntaub ntawv qhia txog kev nce ntxiv ntawm ob qho tib si kev muaj thiab kev siv Cov Kev Txhawb Nqa Hauv Zej Zog, qhia txog kev loj hlob tseem ceeb ntawm cov nroog muab cov kev pabcuam no.​​ 

ECM and Community Supports improve Medi-Cal members’ overall health and well-being by addressing both medical and social factors that can impact a person’s health, including housing assistance, medically tailored meals to support short-term recovery, homemakers, and personal services to create a high-touch, person-centered approach to care.​​ 

"Txhua hnub, muaj ntau tus tswv cuab Medi-Cal tau txais txiaj ntsig los ntawm kev saib xyuas tus kheej uas mus dhau qhov chaw ua haujlwm kws kho mob lossis tsev kho mob ib txwm muaj," Tus Thawj Coj DHCS Michelle Baass hais. Kev Tswj Xyuas Kev Kho Mob Zoo Dua thiab Kev Txhawb Nqa Hauv Zej Zog yog ob lub hauv paus tseem ceeb ntawm kev hloov pauv Medi-Cal, thiab peb pom cov lus teb zoo heev. Tiamsis tseem muaj chaw los pab ntau tus neeg ntxiv.​​ 

"California Advancing and Innovating Medi-Cal (CalAIM) yog ib qho kev siv zog ua tus thawj coj hauv lub tebchaws uas xav tau kev txhawb nqa ntawm txhua tus neeg, cov koom haum, thiab cov phiaj xwm kev noj qab haus huv uas ntseeg siab rau kev muab kev saib xyuas rau cov tswv cuab," Tus Thawj Coj Medicaid ntawm Xeev Tyler Sadwith tau hais. "Peb tab tom ua haujlwm nrog cov neeg koom tes, cov chaw muab kev pab, thiab cov phiaj xwm kho mob Medi-Cal kom ntseeg tau tias cov tswv cuab thiab lawv cov neeg saib xyuas paub tias lawv tuaj yeem nkag mus rau cov kev pabcuam hloov pauv no tau yooj yim."​​ 

COV NTAUB NTAWV QHIA LI CAS: Txij li Lub Ib Hlis Ntuj xyoo 2024, muaj 23 lub nroog tau muab tag nrho 14 qhov kev txhawb nqa hauv zej zog, thiab txhua lub nroog tau muab tsawg kawg yog xya qhov kev txhawb nqa hauv zej zog. Qhov no yog qhov nce ntxiv tseem ceeb los ntawm qhov kawg ntawm xyoo 2022, thaum tsuas muaj peb lub nroog muab tag nrho 14 qhov kev txhawb nqa hauv zej zog. Zuag qhia tag nrho, kwv yees li ntawm 103,000 tus neeg California (los ntawm Medi-Cal) tau siv Kev Txhawb Nqa Hauv Zej Zog hauv 21 lub hlis thawj zaug ntawm qhov kev pab cuam, nrog rau ntau dua 186,000 qhov kev pabcuam tag nrho. Muaj kev loj hlob tseem ceeb ntawm kev siv peb lub hlis dhau peb lub hlis; kwv yees li ntawm 62,000 tus neeg California (los ntawm Medi-Cal) tau siv Kev Txhawb Nqa Hauv Zej Zog hauv peb lub hlis (Q) 3 2023 xwb, nce 170 feem pua ntawm Q4 2022.​​ 

Tsis tas li ntawd xwb, tus naj npawb ntawm cov neeg California uas tau txais Medi-Cal los ntawm ECM txhua lub quarter tau nce ntxiv; hauv Q3 2023, kwv yees li 86,000 tus tswv cuab tau txais ECM, nce 28 feem pua ntawm Q4 2022. Tag nrho Q3 2023 suav nrog 6,300 tus tswv cuab hnub nyoog qis dua 21 xyoo, ntau tus ntawm lawv tau tsim nyog rau ECM thaum Lub Xya Hli 2023. Tag nrho, ntau dua 160,000 tus tswv cuab Medi-Cal thoob plaws lub xeev tau txais ECM hauv 21 lub hlis thawj zaug ntawm qhov txiaj ntsig.​​ 

VIM LI CAS QHOV NO TSEEM CEEB: Qhov hloov tshiab tshiab no qhia txog kev siv ntau ntxiv thaum cov Populations of Focus (POF) ntxiv tsim nyog rau ECM thiab cov kev pabcuam txhawb nqa hauv zej zog ntxiv tau muab rau hauv cov nroog thoob plaws lub xeev.​​ 

DHCS xav tias yuav pom muaj kev loj hlob ntawm cov neeg sau npe thoob plaws ECM thiab Kev Txhawb Nqa Hauv Zej Zog hauv cov hlis thiab xyoo tom ntej. Thaum California txuas ntxiv hloov pauv Medi-Cal, ECM thiab Kev Txhawb Nqa Hauv Zej Zog ua lub luag haujlwm tseem ceeb hauv kev txhawb nqa kev saib xyuas tus kheej rau cov tswv cuab Medi-Cal uas muaj kev xav tau kev kho mob thiab kev noj qab haus huv nyuaj. DHCS tseem cog lus tias yuav txhawb nqa thiab tswj hwm qhov kev loj hlob no los ntawm kev saib xyuas qhov kev pab cuam, kev txhim kho kev tsim qauv, kev ua kom raws li tus qauv, thiab kev pab txhawb nqa kev txawj ntse ncaj qha.​​ 

LAWV HAIS LI CAS:​​ 

• "Ntawm Pacific Clinics, txhua yam peb ua pab cov neeg uas peb pabcuam kom ua tiav lawv lub hom phiaj kev noj qab haus huv thiab txhawb kev ncaj ncees ntawm kev noj qab haus huv." Kev hloov pauv Medi-Cal yog qhov tseem ceeb rau txoj haujlwm no, " Tus Lwm Thawj Coj ntawm Emerging and Statewide Services Jacquelyn H. Torres tau hais. Los ntawm Kev Txhawb Nqa Hauv Zej Zog, peb muab cov kev tseem ceeb rau kev muaj vaj tse pheej yig rau cov tib neeg thiab cov tsev neeg. Tsis tas li ntawd xwb, Kev Tswj Xyuas Kev Kho Mob Zoo Dua ua kom muaj kev nkag mus rau cov kev pabcuam dav dav uas tsim los ua kom tau raws li cov kev xav tau kev noj qab haus huv nyuaj nrog cov kev pabcuam thiab kev saib xyuas uas txhawb nqa lub neej.​​ 

• “Enhanced Care Management represents a critical new safety net service in California,” said Leticia Galyean, CEO of Seneca Family of Agencies. Seneca is a nonprofit provider of behavioral health services to young people and their families, and currently holds 10 ECM contracts with managed care plans across the state. “Seneca is integrating Enhanced Care Management services with our full continuum of prevention and intensive services for young people, promoting true whole-person care and cross-system integration and collaboration in ways we could not before.”​​ 

TXOG COV KEV PAB CUAM THIAB COV KEV PAB CUAM NO: Cov nyiaj pab ECM muab kev tswj hwm kev saib xyuas uas tsom mus rau tus neeg rau cov tswv cuab Medi-Cal uas muaj kev xav tau kev kho mob thiab kev sib raug zoo nyuaj tshaj plaws. Cov tswv cuab uas tau txais ECM muaj ib tus thawj coj saib xyuas kev noj qab haus huv uas pab lawv sib koom tes saib xyuas kev noj qab haus huv thiab kev pabcuam hauv zej zog, ua rau nws yooj yim dua rau lawv kom tau txais kev saib xyuas zoo thaum lub sijhawm zoo hauv qhov chaw zoo - feem ntau yog qhov chaw uas lawv nyob. Kev Txhawb Nqa Hauv Zej Zog yog 14 qhov kev pabcuam uas muab los ntawm Medi-Cal cov phiaj xwm kev saib xyuas uas tswj hwm los pab cov tswv cuab daws lawv cov kev xav tau kev noj qab haus huv hauv zej zog, xws li kev nkag mus rau hauv tsev nyab xeeb lossis cov zaub mov noj qab haus huv kom pab lawv rov zoo los ntawm kev mob, zam kev kho mob siab dua thiab kim dua, thiab ua neej nyob zoo dua.​​ 

KEV UA HAUJ LWM: DHCS thiab nws cov neeg koom tes hauv kev npaj kho mob tab tom ua haujlwm los nthuav kev nkag mus thiab siv ECM thiab Kev Txhawb Nqa Hauv Zej Zog hauv xyoo 2024 thiab tom qab ntawd los ntawm:​​ 

• Kev nthuav dav nkag mus rau ECM cov txiaj ntsig, nrog rau POFs ntxiv tsim nyog rau ECM pib txij Lub Ib Hlis 1, 2024, thiab nce cov kev pabcuam hauv zej zog muaj nyob hauv txhua lub nroog thoob plaws lub xeev.​​ 
• Txhim kho cov haujlwm thiab cov cai ntawm cov kev pab cuam kom tshem tawm cov teeb meem rau kev cog lus rau cov neeg muab kev pabcuam thiab kev siv cov kev pabcuam los ntawm ECM thiab Txoj Kev Npaj Txhawb Nqa Zej Zog uas suav nrog kev ua kom yooj yim rau kev tso cai thiab cov txheej txheem xa mus, nthuav dav cov tes hauj lwm ntawm cov neeg muab kev pabcuam, thiab txhim kho kev sib pauv cov ntaub ntawv.​​ 
• Muab nyiaj pab thiab kev pab txog kev txawj ntse los txhawb cov neeg muab kev pab hauv kev siv thiab nthuav dav peev xwm rau ECM thiab Kev Txhawb Nqa Hauv Zej Zog los ntawm Kev Muab Kev Nkag Mus Rau thiab Hloov Kev Noj Qab Haus Huv (PATH), uas yog $ 1.85 billion txoj haujlwm pib.​​ 
• Kev tuav cov rooj sib tham tsis tu ncua, suav nrog PATH Collaborative Planning and Implementation (CPI) Cov pab pawg ua haujlwm rau cov neeg muab kev pabcuam thiab cov neeg zej zog thoob plaws lub xeev, txais tos cov lus pom zoo rau kev siv ECM thiab Kev Txhawb Zej Zog los ntawm ntau pawg neeg koom nrog rau cov neeg muab kev pabcuam thiab cov neeg zej zog thoob plaws lub xeev.​​ 
• Txhawb nqa cov phiaj xwm kev saib xyuas kev tswj hwm kom nce kev siv ECM thiab Kev Txhawb Zej Zog los ntawm Qhov Kev Pabcuam Nyiaj Txiag.​​ 
• Kev nthuav dav thiab siv ntau txoj hauv kev raws li qhov yuav tsum tau muaj hauv daim ntawv cog lus saib xyuas kev tswj hwm los txheeb xyuas cov tswv cuab uas yuav tau txais txiaj ntsig los ntawm ECM thiab Kev Txhawb Zej Zog. Qhov no tseem suav nrog kev ua kom muaj kev sib cog lus ntawm cov chaw muab kev pabcuam paub txog ECM cov txiaj ntsig thiab Cov Kev Pabcuam Hauv Zej Zog thiab cov kev tsim nyog tau txais dab tsi, thiab ua kom pom tseeb txoj hauv kev xa mus rau cov kev npaj saib xyuas.​​ 
• Ua kom muaj kev tswj xyuas cov phiaj xwm kev saib xyuas rau pej xeem cov vev xaib, cov tswv cuab hauv phau ntawv qhia, thiab cov chaw kho mob cov ntaub ntawv suav nrog cov ntaub ntawv tshiab tshaj plaws txog ECM thiab Cov Kev Txhawb Zej Zog muaj thiab yuav nkag mus rau lawv li cas.​​ 

BIGGER PICTURE: DHCS is transforming Medi-Cal to ensure Californians can get the care they need to live healthier lives. Medi-Cal members have access to new and improved services and receive comprehensive care that goes beyond the doctor’s office or hospital and addresses all of their physical and mental health needs. These changes will create a more coordinated, person-centered, and equitable health system that works for everyone, regardless of race, ethnicity, gender, sexual orientation, disability, immigration status, location, or health needs.​​ 

Medi-Cal yog tus thawj coj hauv lub tebchaws hauv kev muab cov neeg California nkag mus rau kev saib xyuas lawv xav tau los tsim kom muaj lub xeev muaj kev noj qab haus huv thiab sib luag.​​ 

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