Rov qab mus rau Lub Rau Hli 2022 Cov Neeg Koom Tes Kev Sib Txuas Lus Hloov Tshiab​​ 

Medi-Cal COVID-19 Public Health Emergency (PHE) Operational Unwinding Plan​​ 

On May 17, DHCS released the Medi-Cal COVID-19 PHE Operational Unwinding Plan. The two primary purposes of the plan are to: 1) describe DHCS’ approach to unwinding or making permanent the temporary flexibilities implemented across the Medi-Cal program during the PHE; and 2) describe DHCS’ approach to resuming normal Medi-Cal eligibility operations following the end of the PHE. The PHE is currently set to expire on July 15, 2022, and the U.S. Department of Health and Human Services (HHS) has committed to providing at least a 60-day notice prior to the official PHE end date.​​ 

Since the initiation of the PHE, DHCS implemented more than 100 programmatic flexibilities to help minimize the strain to the Medi-Cal program, its beneficiaries, and California’s health care providers and systems. While many of these programmatic flexibilities will terminate on or around the end of the PHE, some will continue due to the positive impact they have made on the Medi-Cal program. Additionally, under the continuous coverage requirement in the Families First Coronavirus Response Act, states are required to maintain enrollment of nearly all Medicaid enrollees through the end of the month in which the PHE ends. When continuous coverage requirements expire, states must conduct a full redetermination for all beneficiaries who would otherwise have been subject to redetermination.​​ 

The Operational Unwinding Plan is intended to inform the public of DHCS’ approach to return Medi-Cal to a normal state of operations. The document also includes additional resources, including information about the DHCS Coverage Ambassadors campaign and links to the Centers for Medicare & Medicaid Services’ (CMS) guidance documents.​​ 

Governor’s May Revision​​ 

On May 13, Governor Newsom unveiled his $300 billion fiscal year (FY) 2022-23 May Revision budget proposal, which is an increase of approximately $14 billion compared to the budget released on January 10, 2022. The state now has a projected surplus in excess of $86 billion that is reflected in increased budgetary reserves as well as an increased use of discretionary surplus amounts to fund one-time projects. The Governor’s May Revision proposes a $141.8 billion total funds ($37 billion General Fund) budget for DHCS programs and services. The total amount is allocated between $1.6 billion in DHCS state operations and $140.2 billion that supports funding for program costs, partners, and administration.​​ 

COVID-19 PHE txuas ntxiv cuam tshuam rau DHCS pob nyiaj siv, uas qhia txog tag nrho cov nuj nqis ntsig txog PHE ntawm $ 11.5 billion tag nrho cov nyiaj. Qhov kev cuam tshuam no suav nrog kev txuas ntxiv tsis ntev los no ntawm PHE mus txog Lub Xya Hli 15, 2022. Cov kev hloov tshiab tseem ceeb rau qhov kev xav tau ntawm qhov cuam tshuam ntawm COVID-19 suav nrog cov nqi cuam tshuam nrog kev tsis txaus siab ntawm PHE (suav nrog kev txiav txim siab tsim nyog); txuas ntxiv cov nqi sib cais los ntawm Tsoom Fwv Teb Chaws Saib Xyuas Kev Noj Qab Haus Huv Muaj Peev Xwm rau kev tswj hwm tshuaj tiv thaiv; txuas ntxiv ntawm kev tsim nyog tsim nyog rau cov tib neeg hnub nyoog 65 thiab laus dua, dig muag lossis tsis taus; thiab ib lub hlis twg ntxiv ntawm cov nyiaj tau los cuam tshuam nrog nce Tsoom Fwv Teb Chaws Kev Pab Kho Mob Feem Xyuam (FMAP).​​ 

The May Revision includes a significant additional investment in the Equity and Practice Transformation Payment program ($700 million total funds) to advance equity, address gaps in preventive, maternity, and behavioral health care measures, reduce disparities driven by COVID-19, and support practices to transition from fee-for-service reimbursement (where providers are paid for visits/volume and not quality/outcomes) to value-based payments/alternative payment models (e.g., capitated payments tied to quality outcomes)). This aligns with the goals of the Medi-Cal Comprehensive Quality and Equity Strategy and the Bold Goals of 50×2025 initiative. Preparing practices for value-based care also includes implementing practice infrastructure, such as electronic health records and improved data collection and exchange.​​ 

The May Revision also proposes $933 million for one-time retention payments to approximately 600,000 California hospital and nursing facility workers who have been at the frontlines delivering care to the most acute patients during the COVID-19 Pandemic. The ongoing response to COVID-19 has significantly impacted California’s workforce in hospitals and nursing facilities. Retaining essential workers in these settings is a priority of the Administration, and these payments are designed to help retain this critical workforce in an environment of high vacancies and turnover. The state will provide a baseline payment and will increase the payment up to $1,500 if employers commit to fully matching the additional amount, subject to available funding.​​ 

Tsis tas li ntawd, DHCS tau koom tes nrog California Lub Chaw Pabcuam Kev Noj Qab Haus Huv & Tib Neeg los muab nyiaj pab ($ 85 lab General Fund) los txhawb kev noj qab haus huv thiab txhim kho cov menyuam yaus, hluas, thiab cov niam txiv.  Cov kev pab cuam no, uas yuav pab tau cov tub ntxhais hluas uas raug cuam tshuam los ntawm kev raug mob, kev ntxhov siab, thiab kev sib cais ntawm kev sib raug zoo los ntawm PHE, yuav muab nyiaj pab ntxiv rau Children and Youth Behavioral Health Initiative rau cov tsev kawm ntawv, nroog, cov nroog, Cov Pab Pawg, thiab cov koom haum hauv zej zog (CBOs).​​ 

DHCS tab tom thov kom muab nyiaj pab ntau dua ($ 60 lab nyiaj tag nrho) rau Cov Neeg Sau Npe Kev Noj Qab Haus Huv Navigator los txuas ntxiv cov haujlwm ua haujlwm, nrog rau kev hais txog COVID-19 PHE cov dej num, tshwj xeeb yog pab cov neeg tau txais txiaj ntsig khaws Medi-Cal kev pab cuam los ntawm kev pab nrog kev rov ua dua tshiab txhua xyoo, tshaj tawm cov ntaub ntawv tiv tauj tshiab, thiab koom nrog kev nthuav dav rau cov pej xeem nyuaj.​​ 

Lub Tsib Hlis Hloov Kho suav nrog kev thov rau $ 10 lab hauv ib zaug Opioid Settlement Funds txhawm rau txhim kho Lub Ib Hlis Lub Ib Hlis Kev Pabcuam Kev Kho Mob Expansion Project thov los ntawm kev nce kev faib tawm ntawm naloxone rau cov neeg tsis muaj tsev nyob. Tsis tas li ntawd, DHCS tab tom thov kom ntxiv rau Lub Ib Hlis qhov kev pom zoo ntsig txog kev siv tshuaj yeeb tsis zoo rau cov neeg ua haujlwm kev cob qhia los ntawm $ 29.1 lab.​​ 

View the DHCS May Revision budget highlights and the Medi-Cal and Family Health Local Assistance Estimates.​​ 

Medi-Cal Rx Kev Hloov Kho Kev Ua Haujlwm​​ 

Txij li thaum Lub Ob Hlis 2022, Medi-Cal Rx tau ua kom lub chaw hu xov tooj ruaj khov thiab kev tso cai ua ntej (PA) ua haujlwm. Txij thaum ntawd los, DHCS thiab Magellan (MMA) tau koom nrog cov txheej txheem kev npaj ua haujlwm hnyav rau theem rov ua haujlwm ntawm kev thov hloov kho thiab PA cov cai. Peb-theem mus kom ze, qhia los ntawm cov tswv yim tawm tswv yim, pib nrog kev rov qab los ntawm ib qho me me thiab xaiv pab pawg ntawm cov ntawv thov hloov kho thiab PAs los ntawm chav kawm tshuaj; tsiv mus rau rov ua dua txhua qhov PAs uas raug rau kev txo qis hauv lub Ob Hlis 2022 thaum ntxov; thiab nyob rau theem kawg, so haujlwm txoj cai hloov pauv. Txoj kev rov ua dua tshiab yog maj mam thiab rov ua dua nrog kev mob siab rau cov neeg koom nrog kev npaj thiab saib xyuas kev ua haujlwm. Nws yuav raug kho kom zoo raws li qhov tsim nyog nyob rau lub sijhawm raws li kev txheeb xyuas cov ntaub ntawv, kev paub txog kev ua haujlwm, thiab cov lus tawm tswv yim ntawm cov neeg koom nrog. Cov neeg muaj feem raug txhawb kom tawm tswv yim thiab muab cov lus tawm tswv yim ntawm txoj hauv kev no los ntawm kev mob siab rau email inbox, Reinstatement@dhcs.ca.gov.​​  

Pawg Neeg Saib Xyuas Neeg Mob Tshwj Xeeb Liaison​​ 
Using feedback from various stakeholders, Medi-Cal Rx has created a Special Populations Clinical Liaison Team within the Customer Service Center that is trained to serve the specific needs of populations enrolled in California Children’s Services, the Genetically Handicapped Persons Program, and those who have specialty behavioral health conditions. This team is comprised of pharmacy technicians and pharmacists.​​ 

Pib txij lub Tsib Hlis 9, Pawg Neeg Saib Xyuas Kev Pabcuam Tshwj Xeeb muaj nyob rau hnub Monday txog Friday, 8 teev sawv ntxov txog 8 teev tsaus ntuj, tsis suav cov hnub so, thiab pab cov neeg tau txais txiaj ntsig, cov chaw muab kev pabcuam, thiab cov neeg siv hauv nroog uas muaj peev xwm txheeb xyuas thiab sib tham txog cov ntaub ntawv tiv thaiv kev noj qab haus huv rau cov neeg tau txais txiaj ntsig. Medi-Cal Rx tau cog lus tias yuav xa cov kev pab cuam muag tshuaj raws sij hawm thiab nyab xeeb rau Medi-Cal cov neeg tau txais txiaj ntsig thiab cov kws kho mob thoob plaws California.​​ 

DHCS is also ensuring that providers are kept updated and that relevant information is communicated to them via e-mail blasts, provider newsflashes, information on the DHCS and Medi-Cal Rx websites, and direct provider outreach. These actions are designed to ensure that Medi-Cal beneficiaries can get the prescription drugs they need when they need them. For questions or comments related to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.​​   

Ntshav Siab Cuffs thiab Saib Xyuas​​ 
Pib txij Lub Rau Hli 1, Kev Siv Tus Kheej Cov Tshuaj Ntshav Siab thiab Ntshav Cuffs tau ntxiv los ua Medi-Cal Rx ib feem ntawm cov txiaj ntsig ntawm lub khw muag tshuaj. Cov khoom no raug txwv rau ib daim ntawv teev cov khoom siv thiab cuffs, thiab raug xaiv tom qab ua tib zoo tshuaj xyuas thiab cov neeg koom tes thiab cov neeg muab kev pab tswv yim. Ntxiv cov khoom no raws li cov nyiaj pab them rov qab hauv tsev muag tshuaj yuav txhim kho kev nkag mus rau kev saib xyuas, thiab cov txiaj ntsig no tseem yuav muaj ntxiv raws li cov khoom siv kho mob uas tau them rau ntawm daim ntawv thov kho mob. Medi-Cal Rx cov npe ntawm cov khoom siv khomob uas tau piav qhia thiab cov ntaub ntawv them nqi thiab Medi-Cal Rx tus kws kho mob phau ntawv yuav raug hloov kho kom muaj kev cuam tshuam cov ntxiv no. Yog muaj lus nug lossis lus nug, thov xa email mus rau Medicalsupplies@dhcs.ca.gov.​​ 

Medi-Cal Qhov Kev Pab Cuam Tiv Thaiv Kab Mob Khaus Viv-19​​ 

DHCS allocated up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system from September 1, 2021, through February 28, 2022. Medi-Cal managed care plans (MCPs) were 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. The third outcome ascertainment period for the program ended on March 6. Between January 3 and March 6, the total vaccination rates showed improvement in all reported measures. On March 6, target goals for all vaccine outcome measures increased to closing 100 percent of the gap between Medi-Cal and county rates, which was a challenge for plans to meet. Three beneficiary sub-groups (ages 12-25 years, African Americans, and American Indian/Alaska Natives) were within 5 percent of closing two-thirds of the gap. For the high performance pool measures, preliminary data demonstrate that eight MCPs achieved targets of at least one dose for members age 5-11 years, and two MCPs achieved targets for fully vaccinated and boosted members age 12 years and older. For more information, please refer to All Plan Letter (APL) 21-010, Attachment A.​​