Medi-Cal Benefits Policy Branch
One of the four branches within the Department of Health Care Services (DHCS), Benefits Division (BD) is the Medi-Cal Benefits Policy Branch, which oversees updates to the Medicaid State Plan, including State Plan Amendments (SPAs), regulatory updates, contracts with other state agencies (called Interagency Agreements (IAs)), Title XIX claiming, legislative bill analyses, certain high-visibility Medi-Cal benefits policy areas, and more.
Medicaid State Plan, including SPAs
The Medicaid State Plan is based on the requirements set forth in Title XIX of the Social Security Act (SSA) and is a comprehensive written document created by DHCS that describes the nature and scope of its Medicaid (Medi-Cal) program, which serves as a contractual agreement between the State of California and the federal Centers for Medicare and Medicaid Services (CMS) and must be administered in conformity with specific requirements of Title XIX of the SSA and regulations outlined in Chapter IV of the Code of Federal Regulations. The State Plan contains all information necessary for CMS to determine if the State can receive Federal Financial Participation (FFP) for Medi-Cal.
Regulations
The Medi-Cal Benefits Policy Branch is responsible for promulgating regulation packages to make any necessary updates to Title 22 of the California Code of Regulations (CCR), relating to Medi-Cal. This will typically include updates due to statutory changes as a result of legislation but may also be changes to ensure alignment with changes in Medi-Cal benefits coverage policy.
Contracts / IAs
The Medi-Cal Benefits Policy Branch is responsible for developing, executing, and overseeing contracts, including IAs with other State departments, related to Medi-Cal covered benefits as well as other services and supports provided to Medi-Cal members. Currently, BD oversees contracts with the following State Departments:
- California Department of Public Health (CDPH)
- California Department of Social Services (CDSS)
- California Department of Developmental Services (CDDS)
- First 5 California
Title XIX Claiming
The Medi-Cal Benefits Policy Branch created a Title XIX Claiming Toolkit to provide additional guidance and clarification to other State departments as well as local and county partners around appropriately documenting and seeking reimbursement for Title XIX matching funds through the various IAs maintained between DHCS and other State departments
Title XIX claiming must be done in accordance with all applicable federal statues, regulations, and policies, including, but not limited to, the federal CMS regulations and policies, including pertinent State Medicaid Director letters, federal Medicaid claiming requirements; Office of Management and Budgets (OMB) Circulars; as well as other State-issued policy guidance as applicable.
To contact the Medi-Cal Benefits Policy Branch regarding Title XIX claiming issues, please contact us via email at Title19ClaimingBD@dhcs.ca.gov.
Legislative Bill Analyses
The Medi-Cal Benefits Policy Branch is responsible for evaluating proposed and enacted state and federal bills to assess what impact they may have, if any, to the current schedule of Medi-Cal benefits and providing recommendations to DHCS leadership.
Medi-Cal Benefits Policy Areas
DHCS added doula services as a covered benefit on January 1, 2023. Doula services are available in fee-for-service and through Medi-Cal MCPs. Services include personal support to individuals and families throughout pregnancy and one year postpartum. This includes emotional and physical support provided during pregnancy, labor, birth, and the postpartum period, as well as support for and after miscarriage and abortion.
The Doula Implementation Workgroup (the Workgroup) is required by Senate Bill (SB) 65, which added section 14132.24 to the Welfare and Institutions Code (W&I Code).
DHCS added CHW services as a Medi-Cal benefit starting July 1, 2022. CHW services are preventive health services to prevent disease, disability, and other health conditions or their progression; to prolong life; and promote physical and mental health and well-being.
Medi-Cal covers all medically necessary BHT for eligible member under 21 years of age, which may include children with autism spectrum disorder (ASD) as well as children for whom a physician or psychologist determines it is medically necessary.
Medi-Cal's telehealth policy allows Medi-Cal providers to deliver clinically appropriate services via various telehealth modalities, as outlined in more detail in the Medicine: Telehealth section of the Provider Manual.
Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal, which includes nonemergency medical transportation (NEMT) and nonmedical transportation (NMT). This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies.
DHCS added dyadic services as a benefit effective January 1, 2023. Dyadic services are available to Medi-Cal members in fee-for-service (FFS) and through managed care plans (MCPs). Dyadic services are a family and caregiver focused model of care intended to address developmental and behavioral health conditions of children and includes services provided to parent(s)/caregiver(s) (known as a “dyad"). Dyadic services help improve access to preventive care for children and rates of immunization completion. They also address coordination of care, child social-emotional health and safety, developmentally appropriate parenting, and maternal mental health.
Contact Information
To contact the DHCS/BD's Medi-Cal Benefits & Medical Policy Branch, please email us at Medi-Cal.Benefits@dhcs.ca.gov.
