Tsib Hlis 27, 2025
Xov xwm tshaj plaws
Daim Ntawv Qhia Txog Tus Cwj Pwm Tshiab Kev Noj Qab Haus Huv (BHSA) Kev Txhawb Nqa Nyiaj Tau Los thiab Kev Npaj
DHCS released the BHSA Revenue Stability Workgroup Report with recommendations to reduce the variance of county Behavioral Health Services Funds (BHSF). The recommendations are intended to help counties manage revenue more consistently, maintain services through economic ups and downs, and bring greater predictability and accountability to local behavioral health care funding.
The BHSA Revenue Stability Workgroup, comprising state leaders and counties, was required to develop and recommend solutions to reduce BHSA revenue volatility and propose appropriate prudent reserve levels to support the sustainability of county programs and services. It reviewed and analyzed current and historical revenues generated by the MHSA and the BHSA and prudent reserve levels to develop the recommendations.
The State Controller’s Office will continue to follow the current process to distribute BHSA local assistance funds to counties monthly. The goal is to balance local assistance revenue allocation and program stability, helping counties effectively plan and provide critical behavioral health services during revenue downturns. Highlights include:
- Kev siv nyiaj txhua xyoo raws li qhov nruab nrab peb xyoos, hloov kho rau kev nce nqi.
- Tshiab txwv txwv (10-15 feem pua, nyob ntawm lub nroog loj).
- Ib zaug yuav tsum tau siv nyiaj ntau dhau ntawm 2026-2029.
- Yooj yim los kho cov peev nyiaj yog tias cov nyiaj tau los poob.
- Ntau pob tshab, nrog rau kev tshaj tawm pej xeem thiab cov tswv yim hauv zej zog.
This approach supports California’s Mental Health for All vision by promoting stability, transparency, and community-centered behavioral health care. State legislation is required to enact recommendations from the BHSA Revenue Stability Workgroup Report.
Kev Pabcuam Hauv Zej Zog Qhia Txog Tus Nqi Thaum Ntxov Thaum Ua Raws Li Medi-Cal Cov Tswv Cuab xav tau
DHCS recently submitted to the Centers for Medicare & Medicaid Services (CMS) its Community Supports, or In Lieu of Services (ILOS), Annual Report[TO1] , which reviews the progress and impact of Medi-Cal Community Supports in 2024. For the first time, the report also includes a cost-effectiveness analysis for 2023. The report highlights key achievements, such as reduced emergency room visits, hospitalizations, and long-term care use, pointing to early evidence of both improved health outcomes and reduced costs when compared to the services they are replacing, such as inpatient, emergency department, and long-term care services. Of the 12 Community Supports studied, nine are already proving cost-effective, and the remaining three are expected to prove to be cost-effective over time.
The report also outlines operational improvements made by DHCS and managed care plans (MCP) to expand services, grow provider networks, and support implementation. While progress has been significant, the report also identifies ongoing challenges and opportunities for further improvement, ensuring these services continue to evolve to meet the needs of Medi-Cal members.
Kev hloov kho tshiab
Medi-Cal Kev Lag Luam MCP Kev Muag Khoom Hloov Tshiab
DHCS will postpone the next commercial Medi-Cal MCP procurement by at least two years. The next competitive procurement for MCPs will begin no sooner than 2029, with contracts expected to take effect no sooner than 2031. DHCS previously indicated that the re-procurement for commercial MCPs would be conducted once every five years. Under this assumed timeline, DHCS would have had to release the Request for Proposal (RFP) in 2027 for a contract effective date of January 1, 2029.
The additional time will allow DHCS to focus on critical California Advancing and Innovating Medi-Cal (CalAIM) initiatives. It will also help maintain stability for members and support ongoing improvements to care quality and access, while also supporting the long-term success of the Medi-Cal managed care program.
In accordance with current policy, MCP contracts will be renewed annually following the contractual requirements identified in Exhibit E, 1.1.15 of the 2024 Managed Care Boilerplate Contract. Current MCP contracts will be extended from January 1, 2026, to December 31, 2026, by the established annual process. DHCS remains committed to fostering an inclusive, flexible, and responsive process that supports the Medi-Cal program and ensures continued equitable access to high-quality care for Californians. Please visit the Medi-Cal Managed Care webpage for more information.
Kev Hloov Kho Hniav Tswj Kev Kho Hniav
During the week of May 26, DHCS will mail a 30-day notice to about 350,000 Medi-Cal members in Sacramento and Los Angeles counties to notify them of upcoming changes to their dental service delivery, effective July 1, 2025. The member notice explains what is changing, if the member needs to make a plan choice, the member’s continuity of care protections, and other important information, and will include a Medi-Cal managed care enrollment packet.
Members in Sacramento County who are currently enrolled in Access Dental Plan or dental fee-for-service (FFS) must select a new Dental Managed Care plan, while members in Los Angeles County who do not choose a Dental Managed Care plan will remain in FFS. Members currently enrolled with Health Net or Liberty will not be affected by these changes. Additionally, changing Dental Managed Care plans will not affect Medi-Cal coverage or benefits.
Medi-Cal Health Care Options is conducting an outbound call campaign to members who receive a managed care enrollment packet. During these calls, HCO representatives will review available Dental Managed Care plan choices, answer questions, and facilitate enrollment in the member’s chosen plan over the phone. DHCS developed the Dental Transition Member Notices webpage for members to view notices and other information about the Dental Managed Care transition.
Medi-Cal Requirements thiab Cov txheej txheem rau npe rau cov kws kho mob
Effective August 1, 2025, pharmacy providers that hold a valid Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver and current Certificate of California Clinical Laboratory Registration may bill for CLIA-waived tests provided within the pharmacist’s scope of practice as defined by the California State Board of Pharmacy and authorized in Business and Professions Code Section 4052.4. Pharmacy providers must apply to enroll in the Medi-Cal program by submitting a Medi-Cal provider enrollment online application, along with all supporting documentation.
On June 10, from 10 to 11 a.m. PDT, DHCS will hold a public stakeholder hearing via webinar (advance registration required) to discuss the draft regulatory provider bulletin entitled, “Medi-Cal Enrollment Requirements and Procedures for Pharmacy Providers that Hold a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver.”
Written comments, questions, or suggestions may be submitted during the hearing in the webinar chat. For those unable to attend, written comments must be submitted by 5 p.m. PDT on June 10 to be considered for publication. When submitting written comments, please ensure that the commenter and organization/association being represented are both identified in the comments. Please submit written comments to DHCSPEDStakeholder@dhcs.ca.gov. Based on the public comments received, DHCS will publish the final bulletin on the Medi-Cal providers and DHCS Provider Enrollment Division websites.
Koom nrog peb pab neeg
DHCS tab tom nrhiav ib tus neeg muaj peev xwm thiab muaj kev txhawb siab los ua haujlwm xws li:
- Chief, Capitated Rates Development Division. Tus Thawj Coj yog tus thawj coj kev teeb tsa tus nqi rau Medi-Cal cov phiaj xwm saib xyuas thiab Cov Kev Pabcuam Txhua-Inclusive Care rau Cov Neeg Laus. Cov dej num suav nrog kev siv cov txheej txheem actuarial los tsim cov nqi capitation thiab saib xyuas kev txhim kho thiab kev siv cov cai thiab cov txheej txheem rau kev them nyiaj rov qab. Tsis tas li ntawd, Tus Thawj Saib Xyuas kom paub meej txog cov txheej txheem nyiaj txiag ua raws li kev xa khoom zoo ntawm kev saib xyuas kev noj qab haus huv thiab ua raws li lub xeev thiab tseemfwv txoj cai lij choj, cov cai, thiab cov cai. Cov ntawv thov yuav tsum xa ua ntej lub Tsib Hlis 30.
- Assistant Deputy Director (ADD), Enterprise Technology Services (ETS). This new ADD role will build collaborative working relationships with DHCS Executive Staff, program partners, and external stakeholders, and assist with leading DHCS’ IT programs and services. Additionally, the ADD will play a vital role in leading the development and implementation of IT policies, system architecture, security, improvements, and solutions for DHCS programs, including Medi-Cal and behavioral health. Applications must be submitted by June 2.
DHCS is hiring for its Medi-Cal managed care, data analytics, Medi-Cal eligibility, and other teams. For more information, please visit the CalCareers website.
Cov Rooj Sib Tham Cov Neeg Koom Tes thiab Webinar yuav los tom ntej
DHCS posts upcoming public meetings on the Calendar of Events. DHCS provides free assistive services, including language interpretation, real-time captioning, and alternate formatting of meeting materials. To request services, please email DHCS at the appropriate contact email address at least ten working days before the meeting.
Kev Pabcuam Ambassador Webinar Series: Birthing Care Pathway
On May 29, from 11 a.m. to 12 p.m. PDT, DHCS will hold a Coverage Ambassador webinar that will focus on DHCS’ Birthing Care Pathway initiative (advance registration required). The webinar will provide information about maternity services for pregnant and postpartum Medi-Cal members from conception through 12 months postpartum and review highlights from the Birthing Care Pathway Report released on February 4. This initiative helps to ensure Medi-Cal members have access to high-quality, equitable care to improve maternal health outcomes and reduce disparities. Coverage Ambassadors will also learn about DHCS’ social media platforms, which offer up-to-date information on relevant topics that can benefit both Coverage Ambassadors and Medi-Cal members. Simultaneous interpretation in Spanish will be offered during the webinar.
Hauv Case Koj Tsis Tau Nws
Thov rau Daim Ntawv Thov (RFA): Cov Kev Pabcuam Vaj Tse yooj yim
On May 7, DHCS announced the Flexible Housing Subsidy Pools (“Flex Pools”) RFA. DHCS will select up to 10 local teams to participate in the Flex Pools TA Academy and receive Flex Pools planning grants of approximately $150,000. The launch of Medi-Cal Transitional Rent and Behavioral Health Services Act (BHSA) Housing Interventions creates an unprecedented opportunity to help people achieve better health outcomes through housing stability.
Flex Pools are intended to help counties and Tribal entities improve housing stability for individuals experiencing or at risk of homelessness. They are a locally designed model to coordinate rental assistance and make the best use of available housing supports, aligning the work of managed care plans, county behavioral health agencies, and other key partners in the homeless services and rehousing systems. Applications are due to DHCS by 5 p.m. PDT on June 13, 2025. Organizations selected will be notified in July 2025. To learn more and apply, please visit the DHCS Housing for Health website.
HCBA Waiver Amendment Application – 30-Hnub Public Comments Period
On May 12, DHCS posted a draft of the 2025 Home and Community-Based Alternatives (HCBA) waiver amendment for a 30-day public comment period, prior to submitting the final version to CMS for reauthorization. The HCBA waiver allows eligible enrollees to receive approved services via the telehealth delivery system. Proposed changes in the waiver amendment include:
- Qhia kom meej cov kev taw qhia thiab kev cia siab rau cov kev pabcuam telehealth.
- Tshem tawm Cov Chaw Kho Mob Nruab Nrab rau Kev Kho Mob Tsis Muaj Kev Kho Mob Nruam (ICF/DD-CN) uas tsis yog qhov cua thiab qhov cua-dependent cov txiaj ntsig thiab kev teeb tsa, vim lawv tab tom hloov mus rau Medicaid State Plan raws li cov txiaj ntsig kev saib xyuas mus sij hawm ntev.
This transition advances California’s efforts to comply with the federal Medicaid Home and Community-Based Settings (HCBS) Final Rule by reinforcing the delivery of services in integrated, community-based settings that support individual choice and autonomy.
DHCS invites all interested parties to review the amendments and comment instructions on the DHCS HCBA Waiver webpage under the HCBA Waiver Amendment Application – 30-Day Public Comment from May 12, 2025 – June 12, 2025 heading. All comments must be received by June 12, 2025. If you have any questions, please email hcbspolicy@dhcs.ca.gov.
Medicaid State Plan Amendment (SPA) – 30-hnub Public Comments Period
On May 12, DHCS posted the ICF/DD-CN: Transition of Benefit/Setting SPA (SPA #25-0026) for a 30-day public comment period, prior to submitting the final version to CMS for approval. ICF/DD-CNs provide 24-hour personal care, developmental services, and nursing supervision for individuals with developmental disabilities who have continuous needs for skilled nursing care and have been certified by a physician and surgeon as warranting continuous skilled nursing care. This service is currently provided through the HCBA waiver. This SPA will transition the ICF/DD-CN benefit/setting from the HCBA waiver to the Medicaid State Plan as a long-term care setting. This transition advances California’s efforts to comply with the federal HCBS Final Rule by reinforcing the delivery of services in integrated, community-based settings that support individual choice and autonomy. All comments must be received by June 12, 2025. If you have any questions, please email PublicInput@dhcs.ca.gov.