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.​​ 

Daim Phiaj Xwm Kev Ua Haujlwm Rov Qab Zoo yog los qhia rau pej xeem txog DHCS txoj hauv kev los rov qab Medi-Cal mus rau qhov xwm txheej ib txwm muaj. Daim ntawv kuj tseem muaj cov peev txheej ntxiv, suav nrog cov ntaub ntawv hais txog DHCS Coverage Ambassadors phiaj xwm thiab cov kev sib txuas mus rau cov ntaub ntawv qhia ntawm Centers for Medicare & Medicaid Services (CMS).​​ 

Governor’s May Revision​​ 

Thaum Lub Tsib Hlis 13, Tus Thawj Kav Xeev Newsom tau tshaj tawm nws daim ntawv thov nyiaj txiag kho dua tshiab $ 300 billion rau xyoo nyiaj txiag (FY) 2022-23 Tsib Hlis, uas yog qhov nce ntxiv kwv yees li $ 14 billion piv rau cov peev nyiaj uas tau tshaj tawm rau Lub Ib Hlis 10, 2022. Tam sim no lub xeev muaj nyiaj seem ntau tshaj $ 86 billion uas pom tseeb los ntawm kev nce nyiaj khaws cia thiab kev siv nyiaj seem ntau ntxiv los pab nyiaj rau cov haujlwm ib zaug xwb. Kev Hloov Kho Dua Tshiab ntawm Tus Thawj Kav Tebchaws thaum Lub Tsib Hlis tau thov kom muaj tag nrho $ 141.8 billion cov nyiaj ($ 37 billion General Fund) rau DHCS cov kev pab cuam thiab cov kev pabcuam. Tag nrho cov nyiaj tau muab faib nruab nrab ntawm $ 1.6 billion hauv DHCS cov haujlwm hauv xeev thiab $ 140.2 billion uas txhawb nqa nyiaj txiag rau cov nqi ntawm qhov kev pab cuam, cov neeg koom tes, thiab kev tswj hwm.​​ 

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).​​ 

Kev Hloov Kho Lub Tsib Hlis suav nrog kev nqis peev ntxiv rau hauv qhov kev pab cuam Equity and Practice Transformation Payment ($ 700 lab tag nrho cov nyiaj) los txhawb kev ncaj ncees, daws qhov sib txawv hauv kev tiv thaiv, kev yug menyuam, thiab kev kho mob tus cwj pwm, txo qhov sib txawv uas tsav los ntawm COVID-19, thiab txhawb nqa cov kev coj ua kom hloov pauv los ntawm kev them rov qab rau tus nqi rau kev pabcuam (qhov twg cov neeg muab kev pabcuam tau them rau kev mus ntsib / ntim thiab tsis yog qhov zoo / cov txiaj ntsig) mus rau kev them nyiaj raws li tus nqi / lwm txoj hauv kev them nyiaj (piv txwv li, kev them nyiaj rau tus kheej khi rau cov txiaj ntsig zoo)). Qhov no sib haum nrog cov hom phiaj ntawm Medi-Cal Comprehensive Quality and Equity Strategy thiab Bold Goals of 50×2025 initiative. Kev npaj cov kev coj ua rau kev saib xyuas raws li tus nqi kuj suav nrog kev siv cov qauv kev coj ua, xws li cov ntaub ntawv kev noj qab haus huv hauv hluav taws xob thiab kev sau thiab sib pauv cov ntaub ntawv zoo dua.​​ 

Kev Kho Dua Tshiab Lub Tsib Hlis kuj tseem thov kom muaj $ 933 lab rau kev them nyiaj ib zaug rau kwv yees li 600,000 tus neeg ua haujlwm hauv tsev kho mob thiab chaw saib xyuas neeg mob hauv California uas tau nyob ntawm kab pem hauv ntej xa kev saib xyuas rau cov neeg mob hnyav tshaj plaws thaum muaj tus kab mob COVID-19 sib kis. Qhov kev teb rau COVID-19 uas tseem niaj hnub ua rau muaj kev cuam tshuam loj heev rau cov neeg ua haujlwm hauv California hauv tsev kho mob thiab cov chaw saib xyuas neeg mob. Kev khaws cov neeg ua haujlwm tseem ceeb hauv cov chaw no yog qhov tseem ceeb ntawm Pawg Neeg Saib Xyuas, thiab cov nyiaj them no yog tsim los pab khaws cov neeg ua haujlwm tseem ceeb no hauv ib puag ncig uas muaj cov neeg ua haujlwm coob thiab cov neeg tawm haujlwm. Lub xeev yuav muab nyiaj them rau tus nqi pib thiab yuav nce qhov nyiaj them mus txog $1,500 yog tias cov tswv haujlwm cog lus tias yuav them tag nrho cov nyiaj ntxiv, raws li cov nyiaj muaj.​​ 

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.​​ 

Saib cov ntsiab lus tseem ceeb ntawm DHCS Kev Hloov Kho Nyiaj Txiag Tsib Hlis thiab Medi-Cal thiab Kev Kwv Yees Kev Pab Cuam Hauv Zos rau Tsev Neeg.​​ 

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 tau muab nyiaj txog li $350 lab los txhawb kev siv zog txhaj tshuaj tiv thaiv COVID-19 hauv Medi-Cal txoj kev tswj hwm kev saib xyuas txij lub Cuaj Hli 1, 2021, txog rau Lub Ob Hlis 28, 2022. Cov phiaj xwm kho mob Medi-Cal (MCPs) tau tsim nyog tau txais nyiaj pab txhawb rau cov haujlwm uas tsim los kaw qhov sib txawv ntawm kev txhaj tshuaj tiv thaiv kab mob nrog lawv cov tswv cuab uas tau sau npe, thiab los daws qhov sib txawv ntawm kev txhaj tshuaj tiv thaiv kab mob rau cov hnub nyoog thiab haiv neeg/pab pawg neeg tshwj xeeb. Lub sijhawm txheeb xyuas qhov tshwm sim thib peb rau qhov kev pab cuam tau xaus rau lub Peb Hlis 6. Nruab nrab ntawm Lub Ib Hlis 3 thiab Lub Peb Hlis 6, tag nrho cov nqi txhaj tshuaj tiv thaiv kab mob tau qhia txog kev txhim kho hauv txhua qhov kev ntsuas uas tau tshaj tawm. Thaum Lub Peb Hlis 6, cov hom phiaj rau txhua qhov kev ntsuas qhov tshwm sim ntawm kev txhaj tshuaj tau nce mus txog 100 feem pua ntawm qhov sib txawv ntawm Medi-Cal thiab cov nqi hauv nroog, uas yog qhov nyuaj rau cov phiaj xwm kom ua tiav. Peb pawg neeg tau txais txiaj ntsig (hnub nyoog 12-25 xyoos, Neeg Asmeskas Dub, thiab Neeg Asmeskas Isdias/Alaska Natives) nyob hauv 5 feem pua ntawm kev kaw ob feem peb ntawm qhov sib txawv. Rau cov kev ntsuas kev ua tau zoo siab, cov ntaub ntawv pib qhia tau tias yim lub MCPs tau ua tiav cov hom phiaj ntawm tsawg kawg ib koob tshuaj rau cov tswv cuab hnub nyoog 5-11 xyoos, thiab ob lub MCPs tau ua tiav cov hom phiaj rau cov tswv cuab uas tau txhaj tshuaj tag thiab tau txais kev txhawb nqa hnub nyoog 12 xyoos thiab laus dua. Yog xav paub ntxiv, thov mus saib Tsab Ntawv Qhia Txog Txhua Txoj Kev Npaj (APL) 21-010, Daim Ntawv Txuas A.​​