Frequently Asked Questions
General
What is Medi-Cal Connect?
Medi-Cal Connect is a statewide data analytics solution and tool for population health management (PHM) designed to help DHCS and its partners improve care for Medi-Cal members. It supports the CalAIM initiative’s goal to modernize Medi-Cal by giving health plans and providers better access to data for care coordination, closing service gaps, and improving health outcomes. Medi-Cal Connect brings together information from trusted sources to show both individual member health and population-level trends. Medi-Cal Connect will keep growing and improving over time, and feedback from partners is essential to making it a useful resource for all.
What are the goals of Medi-Cal Connect?
Personalized whole-person care: Equip Medi-Cal service providers with an expanded view of each member’s risks and unmet needs to provide better care. DHCS will leverage data from various sectors to facilitate a statewide risk stratification and screening algorithm, creating a risk profile for every member.
Improved member experience: Empower Medi-Cal managed care plans (MCP) and behavioral health plans (BHP), care managers, providers, and state and county agencies to deepen their collaboration, anticipate needs, and provide more personalized, timely, and proactive services. This will support meaningful relationships between providers and members that promote longer, healthier, and happier lives and more equitable health outcomes.
Population-level insights: Make it easier for DHCS to gather, analyze, and view data to better understand and respond to health trends among Medi-Cal members.
Informed policymaking and implementation: Strengthen DHCS’ oversight, monitoring, and continuous improvement of the Medi-Cal program, and use analytics and dashboards to drive health equity, accessibility, and quality of care.
Who will have access to Medi-Cal Connect?
Medi-Cal Connect users include:
- DHCS team members
- MCPs
- BHPs
- SP&As*
- Health care delivery partners, including individual providers, provider groups, and federally qualified health centers
- Tribes and Tribal/Urban Indian Organizations (Tribal Health Programs, Indian Health Care Programs).
* SP&As will be onboarded pending data agreement updates.
When will these user groups be able to access Medi-Cal Connect?
Following is the expected timeline for the launch of Medi-Cal Connect:
Release 1*: July 24, 2024: DHCS (limited user group)
Release 2*: March 3, 2025: DHCS (full user group)
Release 3: Quarter 3 2025: MCPs
Phase 1*: Data sharing
Phase 2*: All functions go live, including portals and dashboards
Release 4: Quarter 4 2025: BHPs
Release 5: Quarter 2 2026: Enhancements to support behavioral health measures, no new user groups
Release 6: Quarter 4 2026: Local county providers, PHM program services and supports, health care delivery partners, and Tribal partners
*Go-Live Complete
Have other states launched a similar tool?
No, Medi-Cal Connect is a first-of-its-kind statewide PHM tool. Through Medi-Cal Connect, California is leading the way in improving PHM and data-informed care planning for Medicaid members.
Will Medi-Cal members get access?
Not yet. DHCS chose to pause the rollout of member-facing tools to avoid adding confusion since members already use multiple portals. DHCS is exploring how best to provide member-facing engagement without adding a siloed standalone portal.
Where can I learn more about Medi-Cal Connect?
Please see the following resources:
- Listen to this podcast on CalAIM with Dr. Palav Babaria, DHCS’ Chief Quality Officer, Chief Medical Officer, and Deputy Director of Quality and Population Health Management.
- Visit the Medi-Cal Connect page.
- Sign up for weekly stakeholder updates via the DHCS ListServ.
Data Exchange and Real-Time Sharing
How is Medi-Cal Connect different from a Health Information Exchange (HIE)?
Medi-Cal Connect does not pull data directly from Electronic Health Records (EHR) or provide real-time alerts like an HIE. It uses claims data, which is delayed by at least two to three months. Medi-Cal Connect is not designed to support immediate clinical decisions or to serve as a comprehensive care management platform, but to give care managers helpful historical member information and help provide a picture of the whole person that goes beyond medical care, including public health and social service information. While it may eventually receive HIE data, that is currently not the case.
How does Medi-Cal Connect differ from the Data Exchange Framework (DxF)?
The DxF, managed by CalHHS and created under AB 133, is a statewide policy that guides how health information is shared. It sets standards for real-time data exchange across all providers and payers. Medi-Cal Connect supports the goals of DxF, but it is a PHM tool. Medi-Cal Connect helps users coordinate care and understand health patterns, not carry out real-time clinical exchanges.
How is Medi-Cal Connect different from a Qualified Health Information Organization (QHIO)?
QHIOs play a key role in California’s DxF by facilitating real-time exchange of clinical data, such as EHR information, notifications, and referrals, across all health care and social service entities, regardless of payer or provider type. Medi-Cal Connect, on the other hand, focuses exclusively on the Medi-Cal population and provides a statewide data analytics solution and tool for PHM; it is not a real-time clinical data exchange.
Will Medi-Cal Connect exchange data with QHIOs?
Not at this time. DHCS is exploring future data exchange capabilities between Medi-Cal Connect and QHIOs to strengthen care coordination.
Data and Capabilities
What data sources does Medi-Cal Connect provide that are not typically available through plan data feeds?
Medi-Cal Connect will contain data sources that are not typically available to MCPs and BHPs through the Plan Data Feed supplied by DHCS, such as comprehensive Enhanced Care Management (ECM) and Community Supports data (more shown in table below).
Medi-Cal Connect data sources:
| Data Sources | Description | Plan Data Feed | Risk API | LMR API | Portal |
|---|---|---|---|---|---|
| All-Payer Claims Database Common Data Layout (APCD-CDL)* | Comprehensive claims data, including medical, behavioral, dental, and pharmacy claims, and member demographic information | X | X | X | X |
| Supplemental Eligibility (SUME)** | Enriches core eligibility data by adding detailed member demographic and contact information | X | X | X | |
| ECM/Community Supports (CS) Quality Implementation and Monitoring Report (QIMR) and JavaScript Object Notation (JSON) | Comprehensive ECM and Community Supports data, including encounters and providers or organizations involved in care | X | X | ||
| 274 File | Contains provider attribution data for medical, dental and behavioral health | X | X | ||
| Primary Care Provider Assignment (PCPA) | Contains PCPA and contact information by member | X | X | ||
| Women, Infants, and Children (WIC) | Helps identify members potentially eligible for, but not enrolled in WIC | X | X | ||
| Risk Tiering | Contains Risk Tiering data from data in the APCD-CDL* and SUME** files | X | X | X | |
| Quality Measures | Contains Quality Measures, derived from comprehensive claims data in APCD-CDL and SUME files | X | X | ||
| Programs and Service Flags | Contains program and service eligibility and enrollment flag data derived from APCD-CDL, SUME, ECM/Community Supports QIMR & JSON | X | X |
*APCD-CDL – All-Payer Claims Database Common Data Layout is a standardized format used for collecting healthcare claims data
**SUME – Supplemental Eligibility File is a digital record that contains information beyond basic enrollment data used to determine someone’s eligibility for benefits
Will the RSST methodology be shared with MCPs?
Yes. For more information about the RSST algorithm, read the RSST Transparency Guide Document
Will Medi-Cal Connect replace other data DHCS provides to MCPs?
Not at this time, but DHCS is exploring this possibility.
How does Medi-Cal Connect support the BH-CONNECT and Behavioral Health Transformation (BHT) initiatives?
Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Access, Reform, and Outcomes Incentive Program measures will be calculated and shared through Medi-Cal Connect starting in Release 5 (Quarter 2 2026). BHT will have 5 Healthcare Effectiveness Data and Information Set (HEDIS) measures calculated and shared through Medi-Cal Connect starting in Release 4 (Quarter 4 2025). Visit the BH-CONNECT webpage and BHT webpage for more information.
How much medical information will be captured in Medi-Cal Connect? For example, if someone has diabetes, will we see the history of their diagnosis?
Medi-Cal Connect includes medical claims data starting since 2021. It is not designed for real-time clinical decision-making and does not replace health plan or provider care management systems. Medi-Cal Connect does not contain detailed clinical information from EHRs, such as lab results (e.g., A1C values) or provider notes. If the condition is identified in claims data, it will appear in Medi-Cal Connect. Users will also be able to see the member’s assigned primary care provider and/or clinic, as well as frequently seen specialty providers, behavioral health providers, and care team members (such as care managers).
Will Medi-Cal Connect have a closed-loop referral tracking component?
No. DHCS has separately developed a closed-loop referral tracking policy for ECM and Community Supports. See page 35 of the PHM Policy Guide July 2025 for more information.
Will a member’s data carry over to new MCP assignments or other changes?
Yes. One of Medi-Cal Connect’s goals is to create a LMR that holds member information even when they change MCP and providers. For example, if a member moves between MCPs, the new MCP will have the member’s contact and demographic information, LMR (including diagnoses), risk score, and care plan, if applicable.
For Providers and Plans
What is required of Medi-Cal Connect users?
DHCS will require all MCPs to use its RSST algorithm in 2026. Currently, MCPs are strongly encouraged to use Medi-Cal Connect’s RSST risk tiers, but not required. DHCS defines two distinct time periods:
Initial Implementation Period: This period begins with the launch of the RSST functionalities to MCPs and will end no earlier than July 2026. MCPs will have access to, but not be required to use, DHCS’ standardized RSST risk tiers during this time.
Required Implementation Period: This period begins no earlier than July 2026. MCPs will be required to use DHCS’ standardized RSST tiering.
The RSST algorithm will predict risk across three subdomains (Adverse Events, Underutilization, and Social Risk), standardizing how high-risk members are identified across the state to support more equitable and proactive outreach and care. MCPs will also be required to assess all members identified as high risk by RSST to better understand their needs and connect them to appropriate services. MCPs may continue to use their own risk stratification tools to identify and assess additional high-risk members, but the RSST-flagged population must be addressed at a minimum.
For more information about RSST requirements, please see pages 25-31 of the PHM Policy Guide July 2025.
Will provider organizations and providers be able to access Medi-Cal Connect?
DHCS is aiming to extend access to Medi-Cal providers in Release 6 (Q4 2026).
Privacy and Security
Who can see Medi-Cal Connect data, and how is DHCS safeguarding personal health information (PHI)?
Medi-Cal Connect (Portal, Dashboards, API, Flat File) contains sensitive and personally identifiable information, including PHI. Strict permission management systems are in place to ensure that only authorized entities can access relevant and available member information, ensuring data privacy and security at all times.
Use and disclosure of Medi-Cal Connect data must comply with all applicable federal and state privacy, confidentiality, and security laws, your organization’s data sharing and privacy agreements with DHCS, and DHCS’ Data De-identification Guidelines. Unauthorized use or disclosure may violate applicable state and federal laws, including, but not limited to, the federal Health Insurance Portability and Accountability Act (HIPAA), the Confidentiality of Substance Use Disorder Patient Records (42 C.F.R. Part 2), the California Information Practices Act (IPA), and the Confidentiality of Medical Information Act (CMIA).