Nyob zoo cov neeg koom tes thiab cov neeg muaj feem cuam tshuam,​​ 

Qhov no tau yog ib xyoos zoo kawg nkaus rau Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS). Los ntawm kev ua haujlwm hnyav, kev muaj tswv yim, thiab kev koom tes nrog koj, peb tau ua tiav ntau yam hauv kev txhim kho txoj hauv kev uas peb muab kev kho mob rau ntau lab tus neeg California.​​ 

Raws li tau hais hauv qab no, xyoo 2022 peb tau pib ntau yam kev pib los hloov Medi-Cal; txhim kho kev noj qab haus huv ntawm tus cwj pwm; tswj hwm Medi-Cal txoj kev hloov pauv tawm ntawm COVID-19 kev kub ntxhov rau pej xeem (PHE); thiab txhim kho peb cov haujlwm hauv chav haujlwm kom pab tau cov neeg California zoo dua.​​ 

We look forward to the opportunities together in 2023 as we continue to build on the vision to provide equitable access to quality health care for Californians.​​ 

Hloov pauv Medi-Cal​​ 

California Kev Txhim Kho thiab Kev Tsim Kho Medi-Cal (CalAIM). Peb zoo siab uas tau txais qhov khoom plig Medicaid Innovation Award xyoo 2022, uas tau muab los ntawm Robert Wood Johnson Foundation thiab National Academy for State Health Policy, rau peb txoj haujlwm ntawm kev cog lus tshiab, cov kev pib tshiab los hloov Medi-Cal, tshwj xeeb yog CalAIM.​​ 

CalAIM yog tsim los muab kev saib xyuas rau cov tswv cuab Medi-Cal uas ncaj ncees dua, muaj txhij txhua yam, thiab tsom mus rau tus neeg. Pib thaum Lub Ib Hlis, peb tau siv Enhanced Care Management (ECM) rau cov tswv cuab uas tau txais kev pabcuam los ntawm Whole Person Care pilots thiab Health Homes, thiab tau nthuav dav thoob plaws lub xeev thaum Lub Xya Hli rau cov pej xeem thawj zaug, suav nrog cov neeg tsis muaj tsev nyob, cov neeg siv kev kho mob ntau, thiab cov neeg laus uas muaj mob hlwb loj thiab/lossis muaj teeb meem siv tshuaj yeeb dej cawv. ECM ntsib cov tswv cuab Medi-Cal qhov twg lawv nyob - ntawm txoj kev, hauv chaw nkaum, hauv lawv tus kws kho mob chaw ua haujlwm, lossis hauv tsev - nrog rau 674 tus neeg muab kev pabcuam uas tau sau npe txij li Lub Rau Hli los muab kev sib koom tes saib xyuas kev kho mob tseem ceeb rau 68,400 tus tswv cuab Medi-Cal uas muaj kev xav tau kev kho mob nyuaj tshaj plaws.​​ 

At the same time, managed care plans (MCPs) rolled out Community Supports, which helped 21,600 Medi-Cal members access, in the first half of this year, 14 unique services to address health-related social needs, offered by 725 providers. We released initial data detailing how Medi-Cal members are accessing ECM and Community Supports services, and we will launch a dashboard in 2023.​​ 

Peb kuj tau siv ntau qhov kev pab nyiaj txiag uas yuav pab txhawb peb txoj kev hloov pauv ntawm Medi-Cal, suav nrog:​​ 

• Muab Kev Nkag Mus thiab Hloov Kho Kev Noj Qab Haus Huv (PATH), tsib xyoos, $ 1.85 nphom kev pib tsim kom muaj peev xwm thiab kev tsim kho ntawm cov neeg koom tes hauv av kom muaj kev koom tes hauv Medi-Cal kev xa khoom raws li California tau siv dav hauv ECM, Kev Txhawb Zej Zog, thiab cov kev pabcuam kev ncaj ncees raws li CalAIM.​​ 
• Qhov Kev Pabcuam Tsis Muaj Tsev Nyob thiab Tsis Muaj Tsev Nyob los daws cov neeg tsav tsheb ntawm kev noj qab haus huv thiab kev tsis sib haum xeeb. Medi-Cal MCPs yuav muaj peev xwm khwv tau nyiaj txhawb siab rau kev nqis peev thiab kev vam meej hauv kev daws cov neeg tsis muaj tsev nyob thiab ua kom cov neeg nyob hauv tsev.​​ 
• CalAIM Incentive Payment Program (IPP) los txhawb kev siv thiab nthuav dav ntawm ECM thiab Kev Txhawb Zej Zog los ntawm kev txhawb nqa MCPs los txhawb kev xa cov peev txheej hauv cov chaw muab kev pabcuam thiab kev xa khoom tsim kho; txuas cov silos tam sim no hla lub cev thiab tus cwj pwm kev pabcuam kev noj qab haus huv; txo qhov tsis sib xws ntawm kev noj qab haus huv thiab txhawb nqa kev noj qab haus huv ncaj ncees; ua tiav kev txhim kho hauv kev ua tau zoo; thiab txhawb nqa kev txhawb nqa zej zog.​​ 

New 2024 Managed Care Contract. In February, we released a Request for Proposal formally launching the first-ever statewide procurement for our commercial Medi-Cal MCPs to be effective in January 2024. The new contract that goes into effect in 2024 will apply to all our Medi-Cal MCPs—commercial and the local initiatives. This new contract raises the expectations of our plan partners to create more transparency, accountability, equity, quality, and value, which in turn will translate to better health outcomes.​​ 

Txoj Kev Npaj Zoo Tag Nrho. Thaum ntxov xyoo no peb tau tso tawm peb Txoj Kev Npaj Zoo Tag Nrho, uas muaj kev pom dav dua ntawm qhov zoo, dhau ntawm kev nkag mus thiab cov txiaj ntsig kho mob, los daws ntau yam teeb meem ntawm kev noj qab haus huv ntawm tus kheej thiab lub cev. Peb lub hom phiaj yog los txhim kho kev paub ntawm cov tswv cuab thiab koom nrog lawv los qhia txog txoj cai Medi-Cal; cuam tshuam rau sab saud kom tsev neeg thiab cov zej zog noj qab haus huv los ntawm kev tiv thaiv; muab kev tswj hwm kab mob ntev uas tsom mus rau tus neeg mob; thiab muab kev saib xyuas tus kheej rau cov pej xeem uas muaj kev pheej hmoo siab los ntawm kev daws teeb meem kev noj qab haus huv hauv zej zog. Tsis tas li ntawd xwb, ua ib feem ntawm peb txoj kev npaj zoo peb tau tshaj tawm peb txoj kev npaj ua tiav Bold Goals 50 × 2025. 50 × 2025 yuav suav nrog cov kev pib ua haujlwm tsom mus rau kev saib xyuas kev tiv thaiv menyuam yaus, kev koom ua ke ntawm kev noj qab haus huv, thiab kev saib xyuas cev xeeb tub, tsom mus rau kev ncaj ncees hauv cov cheeb tsam no.​​ 

Medi-Cal txoj Kev Npaj Txhawb Kev Noj Qab Haus Huv thiab Cov cib fim rau Cov Menyuam thiab Tsev Neeg. Peb tau tsim ib txoj cai tswjfwm uas saib rau yav tom ntej rau cov menyuam yaus thiab cov tsev neeg uas tau sau npe rau hauv Medi-Cal. Txoj kev npaj Medi-Cal no ua ke cov xov sib xws ntawm cov kev pib kho mob rau menyuam yaus thiab tsev neeg uas twb muaj lawm thiab tshiab, thiab ua kom DHCS lub luag haujlwm thiab kev saib xyuas cov kev pabcuam rau menyuam yaus ruaj khov.​​ 

Reproductive and Maternal Health. Reproductive and maternal health improvements are a critical part of DHCS’ transformation of Medi-Cal. DHCS this year reaffirmed coverage of and access to comprehensive reproductive health care, including abortion, for Medi-Cal members, and expanded the postpartum period for eligible individuals from 60 days to 12 months. Starting January 1, 2023, DHCS will add doula services to the list of preventive services covered by Medi-Cal, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.​​ 

Other Important Achievements. Here are some other important changes we made to Medi-Cal this year:​​ 

• Tau tsim Medi-Cal Rx los ua kom cov txiaj ntsig ntawm Medi-Cal hauv tsev muag tshuaj muaj tus qauv raws li ib txoj kev xa khoom thoob plaws lub xeev thiab txhim kho kev nkag mus rau cov kev pabcuam tsev muag tshuaj nrog lub network tsev muag tshuaj uas suav nrog feem ntau ntawm cov tsev muag tshuaj hauv lub xeev.​​ 
• Qhia Txog Cov Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zej Zog rau cov kev pabcuam tiv thaiv thaum Lub Xya Hli 1 rau ob qho tib si Medi-Cal tus nqi-rau-kev pabcuam thiab kev tswj xyuas kev pabcuam.​​ 
• Ntxiv Medi-Cal cov cuab tam tsim nyog txwv rau $130,000 rau ib tus neeg thiab $65,000 rau ib tus neeg ntxiv los pab kom cov tswv cuab muaj nyiaj txiag ruaj khov.​​ 
• Ntxiv kev tsim nyog tau txais kev pab them nqi kho mob tag nrho rau cov neeg muaj hnub nyoog 50 xyoo thiab laus dua, tsis hais txog kev nkag tebchaws, thiab raws li Senate Bill 184 (Tshooj 47, Txoj Cai ntawm 2022), pib lub Ib Hlis 1, 2024, cov neeg muaj hnub nyoog 26 txog 49 xyoos yuav tau txais Medi-Cal.​​ 
• Nthuav Medi-Cal tswj kev cuv npe rau kev saib xyuas rau kwv yees li 325,000 tus tswv cuab hauv 2023 uas muaj cai tau txais Medicare thiab Medi-Cal ob leeg. Cov phiaj xwm Medicare Medi-Cal no yog tsim los tswj cov txiaj ntsig thiab kev saib xyuas, kev kho mob thiab kev pab cuam hauv tsev thiab hauv zej zog, thiab cov khoom siv kho mob thiab tshuaj.​​ 
• Reformed the financing of skilled nursing facilities, effective January 1, 2023, to better incentivize and hold facilities accountable for quality patient care and result in the long-term financial viability of facilities in Medi-Cal managed care. We are similarly developing the state’s new Alternative Payment Methodology for participating Federally Qualified Health Centers.​​ 

Advancing Behavioral Health​​ 

We made numerous investments to significantly expand capacity and address gaps within California’s behavioral health continuum.​​ 

CalAIM. CalAIM introduced new behavioral health policies to better meet the needs of Medi-Cal members with substance use disorder and mental health conditions, including:​​ 

• Tso cai rau cov tib neeg tau txais kev pabcuam kev coj tus cwj pwm yam tsis muaj kev kuaj mob thaum lub sijhawm ntsuas.​​ 
• Cov txheej txheem yooj yim rau cov kev pabcuam tshwj xeeb rau kev puas siab puas ntsws kom cov menyuam muaj kev raug mob loj xws li kev tsis muaj tsev nyob lossis kev koom tes hauv kev pabcuam menyuam yaus tau txais kev pabcuam tshwjxeeb rau kev puas hlwb.​​ 
• Created a “no wrong door” policy to ensure individuals do not need to disrupt trusted relationships in one system when they need to receive care in another.​​ 
• Tau txais kev rov ua dua tshiab rau Cov Tshuaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS), uas yog ib feem ntawm CalAIM, uas tau ua tiav hauv 37 lub nroog uas suav txog 96 feem pua ntawm Medi-Cal cov pej xeem. Txoj cai hloov pauv muaj xws li:​​ 
  • Ntxiv cov kev pabcuam Peer Support.​​ 
  • Tshem tawm cov kev txwv ntawm kev kho vaj tse nyob.​​ 
  • Nthuav nkag mus rau cov kev pab cuam rov qab los, suav nrog rau cov tib neeg uas hloov los ntawm kev raug kaw.​​ 
  • Pib DHCS qhov kev sim tswj kev kub ntxhov thaum Lub Ib Hlis 2023, uas muab cov nyiaj txhawb siab los txo cov kev mob nkeeg siv tshuaj stimulant, thiab siv cov kev pabcuam thaum muaj xwm txheej ceev uas Medi-Cal them rau hauv cov kev pabcuam kev noj qab haus huv ntawm lub nroog.​​ 

California Txoj Kev Npaj Tseem Ceeb rau Kev Noj Qab Haus Huv ntawm Lub Siab ntawm Cov Menyuam. Thaum Lub Yim Hli, Tus Thawj Kav Xeev Gavin Newsom tau tshaj tawm California Txoj Kev Npaj Tseem Ceeb rau Kev Noj Qab Haus Huv ntawm Lub Siab ntawm Cov Menyuam kom ntseeg tau tias txhua tus menyuam, cov niam txiv, thiab cov zej zog hauv California tau txais kev pabcuam kev noj qab haus huv ntawm lub siab thiab kev siv tshuaj yeeb ntau dua. Lub Koom Haum Kev Noj Qab Haus Huv Rau Menyuam Yaus thiab Cov Hluas (CYBHI) - tau txais kev pom zoo los ntawm Tus Thawj Kav Tebchaws xyoo 2021 - yog ib feem tseem ceeb ntawm txoj kev npaj. CYBHI yog ib pob nyiaj ntau xyoo, ntau lub chaw haujlwm ntawm kev nqis peev tag nrho $ 4.7 billion uas rov xav txog cov txheej txheem uas yuav txhim kho kev nkag mus rau cov kev pabcuam kev noj qab haus huv rau txhua tus menyuam yaus thiab cov hluas hauv California, tsis hais tus neeg them nyiaj. Tsis tas li ntawd xwb, nws yuav muaj feem cuam tshuam loj rau qhov kev pab cuam Medi-Cal, uas suav nrog 5.4 lab tus menyuam yaus thiab cov hluas.​​ 

Kev Pabcuam Txuas Ntxiv Kev Noj Qab Haus Huv Tus cwj pwm. Yuav kom nthuav cov peev txheej kho mob, xyoo no peb tau muab nyiaj pab yuav luag ib billion daus las hauv Behavioral Health Continuum Infrastructure Program (BHCIP) los ntawm plaub thawj zaug ntawm rau qhov kev pab nyiaj, nrog rau lwm $ 960 lab yuav raug muab rau yav tom ntej. Yog xav paub ntxiv txog kev pab nyiaj thiab khoom plig ntawm BHCIP, thov mus saib BHCIP Data Dashboard.​​ 

BHCIP represents the largest provision of resources for mental health and substance use disorder infrastructure in the state’s history, and an unprecedented opportunity to address historic gaps and make meaningful, sustainable change in California’s behavioral health continuum.​​ 

Lwm Cov Kev Ua Tiav Tseem Ceeb. Nov yog lwm cov kev ua tiav tseem ceeb ntawm DHCS hauv kev noj qab haus huv tus cwj pwm xyoo no:​​ 

• Ua telehealth ruaj khov, uas pab nthuav dav rau kev saib xyuas tus cwj pwm.​​ 
• Muab kev txhawb nqa tseem ceeb rau Kev Ua Phem Txhaum Cai thiab Kev Pabcuam Kev Puas Siab Puas Ntsws 988 Kev tua tus kheej thiab kev kub ntxhov hauv lub vev xaib. Lub vev xaib yog ib qho chaw nres tsheb uas suav nrog cov cuab yeej siv rau cov chaw sib tham daws teeb meem, cov kev pabcuam kev puas siab puas ntsws hauv xeev, cov kws kho mob siv tshuaj, kev noj qab haus huv tus cwj pwm, thiab lwm yam.​​ 
• Muab khoom plig ze li ntawm $ 106 lab hauv tsoomfwv cov lus teb opioid nyiaj pab txhawm rau txhawm rau nkag mus rau Kev Kho Mob Kho Mob (MAT), txo qis kev xav tau kho tsis tau, thiab txo qis opioid thiab fentanyl ntau dhau ntawm kev tuag los ntawm kev tiv thaiv, kho, thiab rov ua haujlwm. Cov phiaj xwm no tsom mus rau cov pej xeem thiab cov chaw uas muaj kev txwv MAT, suav nrog cov tub ntxhais hluas, thaj chaw nyob deb nroog, thiab Asmeskas Khab thiab Alaska Native pab pawg neeg.​​ 
• Pab nyiaj 81 lub chaw saib xyuas xwm txheej ceev los ntawm CalBridge Behavioral Health Navigator Program los nthuav cov neeg ua haujlwm xwm txheej ceev los daws qhov xav tau ceev rau kev saib xyuas tus neeg mob tus cwj pwm.​​ 

Cov lus teb tsis tu ncua rau COVID-19 PHE​​ 

Kev txiav txim siab Medi-Cal​​ Thaum Lub Peb Hlis Ntuj xyoo 2020 , thaum tus kab mob COVID-19 kis thoob plaws ua rau muaj teeb meem PHE, cov txheej txheem tsim nyog Medicaid ib txwm raug ncua kom ntseeg tau tias muaj kev pab them nqi rau cov tib neeg uas tsis muaj zog. Raws li pob nyiaj siv uas Congress tau pom zoo tsis ntev los no thiab Thawj Tswj Hwm Biden tau kos npe rau hauv txoj cai lij choj, California yuav tsum rov pib txiav txim siab dua txog kev tsim nyog Medicaid thaum Lub Plaub Hlis 1, 2023, uas yuav ua rau ntau lab tus tswv cuab poob lawv qhov kev pab them nqi Medi-Cal, txawm tias tsoomfwv PHE tsis tau xaus. Txhawm rau kom txo qhov kev cuam tshuam no rau ntau tus neeg lub neej, DHCS tau tshaj tawm qhov kev pab cuam Tus Neeg Sawv Cev Kev Pab Them Nqi los qhia txhua tus tswv cuab Medi-Cal txog yuav ua li cas kom zoo tshaj plaws kom khaws lawv cov kev pab them nqi kho mob. Feem ntau, peb cov neeg koom tes txhua tus yuav ua lub luag haujlwm tseem ceeb hauv kev tswj hwm cov txheej txheem no kom txo qis kev cuam tshuam rau cov tswv cuab.​​ 

Txoj Kev Npaj Txog Kev Tshem Tawm PHE. Thaum lub Tsib Hlis, DHCS tau tshaj tawm Medi-Cal COVID-19 PHE Operational Unwinding Plan uas piav qhia txog peb txoj hauv kev los daws lossis ua kom ruaj khov cov kev ywj pheej ib ntus uas tau siv thoob plaws hauv Medi-Cal program thaum lub sijhawm PHE thiab peb txoj hauv kev los rov pib ua haujlwm li qub tom qab PHE xaus.​​ 

Health Care Workforce Retention Payments. Also, to stabilize and retain California’s health care workforce during the PHE, DHCS will issue more than a billion dollars in retention payments to workers in qualifying facilities and clinics during the first quarter of 2023.​​ 

Txhim khu kev ua haujlwm ntawm Koom Haum​​ 

Raws li nrog ntau qhov chaw ua haujlwm, DHCS yog qhov chaw sib txawv tam sim no ua tsaug rau kev cog lus, kev ua kom muaj zog, thiab kev tsim kho tshiab ntawm peb pab neeg ua haujlwm sai sai rau kev teb rau COVID-19. DHCS tab tom ua lag luam sib txawv thiab tau siv cov cuab yeej technology, cov cuab yeej, thiab kev cob qhia rau ib qho kev pom zoo, hybrid lub koom haum thiab cov neeg ua haujlwm, suav nrog kev hloov ntawm cov neeg ua haujlwm feem ntau mus rau hauv xov tooj. Peb tau ua kom ntseeg tau tias peb cov neeg koom tes muaj qhov lawv xav tau los txhim kho txoj hauv kev uas peb xa cov kev pabcuam rau ntau lab tus neeg California.​​ 

Further, throughout 2022, our data team supported the analysis and development of new dashboards and data visualizations for telehealth, behavioral health, and long-term support services, among others.​​ 

Qhov tseem ceeb ntawm peb txoj kev koom tes​​ 

Lub Chaw Haujlwm lub hom phiaj los muab kev nkag mus rau kev kho mob pheej yig, sib koom ua ke, thiab zoo rau txhua tus tsuas yog ua tau nrog kev koom tes thiab kev pab los ntawm peb cov neeg koom tes thiab cov neeg muaj feem cuam tshuam - nej txhua tus. Xyoo no peb tau tshaj tawm Txoj Kev Npaj Koom Tes ntawm Pawg Neeg DHCS los muab cov cib fim rau cov neeg sawv cev kev noj qab haus huv ntawm Pawg Neeg thiab Is Nrias teb kom koom nrog kev tsim cov cai Medi-Cal thaum lub rooj sib tham txhua peb lub hlis.​​ 

As we look ahead to 2023, we are excited to complete a statewide listening tour to hear from our partners; launch a Consumer Advisory Committee comprised of Medi-Cal members and family caregivers who will advise DHCS on new ways to improve Medi-Cal; and update our strategic plan to reflect our purpose and priorities.​​ 

Xaus lus, sawv cev rau Pab Pawg DHCS, kuv xav qhia peb txoj kev ris txiaj rau koj rau kev pab peb tsim kom muaj California noj qab haus huv rau txhua tus. Xav kom koj muaj kev nyab xeeb thiab noj qab nyob zoo xyoo tshiab. Tos ntsoov rau cov cib fim ua ke hauv xyoo 2023.​​ 

With gratitude,​​ 

Michelle​​