Mga Minamahal na Kasosyo at Stakeholder,​​ 

This has been quite a year for the Department of Health Care Services (DHCS). Through hard work, ingenuity, and engagement with you, we were able to make great strides in improving the way we deliver health care to millions of Californians.​​ 

As highlighted below, in 2022 we launched many initiatives to transform Medi-Cal; advance behavioral health; manage Medi-Cal’s transition out of the COVID-19 public health emergency (PHE); and enhance our departmental operations to better serve Californians.​​ 

We look forward to the opportunities together in 2023 as we continue to build on the vision to provide equitable access to quality health care for Californians.​​ 

Pagbabago ng Medi-Cal​​ 

California Advancing and Innovating Medi-Cal (CalAIM). We’re proud to have received the 2022 Medicaid Innovation Award, presented by the Robert Wood Johnson Foundation and the National Academy for State Health Policy, for our work on promising, emerging initiatives to transform Medi-Cal, specifically CalAIM.​​ 

CalAIM is designed to provide Medi-Cal members with more equitable, comprehensive, and person-centered care. Starting in January, we implemented Enhanced Care Management (ECM) for members receiving services from Whole Person Care pilots and Health Homes, and expanded statewide in July for initial target populations, including people experiencing homelessness, high-users of health care, and adults with serious mental illness and/or substance use disorders. ECM meets Medi-Cal members where they are – on the street, in a shelter, in their doctor’s office, or at home – with 674 providers enrolled as of June to provide vital care coordination to 68,400 Medi-Cal members with the most complex health care needs.​​ 

At the same time, managed care plans (MCPs) rolled out Community Supports, which helped 21,600 Medi-Cal members access, in the first half of this year, 14 unique services to address health-related social needs, offered by 725 providers. We released initial data detailing how Medi-Cal members are accessing ECM and Community Supports services, and we will launch a dashboard in 2023.​​ 

We also implemented several financing programs that will help drive our transformation of Medi-Cal, including:​​ 

• Ang Providing Access and Transforming Health (PATH), isang limang taon, $1.85 bilyon na inisyatiba upang buuin ang kapasidad at imprastraktura ng mga on-the-ground na kasosyo upang matagumpay na lumahok sa sistema ng paghahatid ng Medi-Cal habang ang California ay malawakang nagpapatupad ng ECM, Mga Suporta sa Komunidad, at mga serbisyong may kinalaman sa hustisya sa ilalim ng CalAIM.​​ 
• Housing and Homelessness Incentive Program upang tugunan ang mga social driver ng mga pagkakaiba sa kalusugan at kalusugan. Makakakuha ang mga Medi-Cal MCP ng mga pondong pang-insentibo para sa paggawa ng mga pamumuhunan at pag-unlad sa pagtugon sa kawalan ng tirahan at pananatili sa mga tao.​​ 
• CalAIM Incentive Payment Program (IPP) upang suportahan ang pagpapatupad at pagpapalawak ng ECM at Mga Suporta ng Komunidad sa pamamagitan ng pagbibigay-insentibo sa mga MCP upang himukin ang pamumuhunan ng sistema ng paghahatid sa kapasidad ng provider at imprastraktura ng sistema ng paghahatid; tulay ang kasalukuyang mga silo sa paghahatid ng serbisyo sa pangangalagang pangkalusugan sa pisikal at asal; bawasan ang mga pagkakaiba sa kalusugan at itaguyod ang pantay na kalusugan; makamit ang mga pagpapabuti sa kalidad ng pagganap; at hikayatin ang pagkuha ng Mga Suporta ng Komunidad.​​ 

New 2024 Managed Care Contract. In February, we released a Request for Proposal formally launching the first-ever statewide procurement for our commercial Medi-Cal MCPs to be effective in January 2024. The new contract that goes into effect in 2024 will apply to all our Medi-Cal MCPs—commercial and the local initiatives. This new contract raises the expectations of our plan partners to create more transparency, accountability, equity, quality, and value, which in turn will translate to better health outcomes.​​ 

Comprehensive Quality Strategy. Earlier this year we released our Comprehensive Quality Strategy, which takes a more expansive view of quality, beyond access and clinical outcomes, to address multiple drivers of health at the individual and system level. Our goals aim to improve member experience and engage them to inform Medi-Cal policy; intervene upstream to keep families and communities healthy via prevention; provide patient-centered chronic disease management; and provide whole person care for high-risk populations by addressing social drivers of health. Additionally, as part of our quality strategy we’ve launched our ambitious Bold Goals 50×2025 initiative. 50×2025 will include focused initiatives around children’s preventive care, behavioral health integration, and maternity care, focusing particularly on health equity within these areas.​​ 

Medi-Cal’s Strategy to Support Health and Opportunities for Children and Families. We launched a forward-looking policy agenda for children and families enrolled in Medi-Cal. This Medi-Cal strategy unifies the common threads of existing and new child and family health initiatives, and solidifies DHCS’ accountability and oversight of children’s services.​​ 

Reproductive and Maternal Health. Reproductive and maternal health improvements are a critical part of DHCS’ transformation of Medi-Cal. DHCS this year reaffirmed coverage of and access to comprehensive reproductive health care, including abortion, for Medi-Cal members, and expanded the postpartum period for eligible individuals from 60 days to 12 months. Starting January 1, 2023, DHCS will add doula services to the list of preventive services covered by Medi-Cal, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.​​ 

Other Important Achievements. Here are some other important changes we made to Medi-Cal this year:​​ 

• Launched Medi-Cal Rx to standardize the Medi-Cal pharmacy benefit under one statewide delivery system and improve access to pharmacy services with a pharmacy network that includes the vast majority of the state’s pharmacies.​​ 
• Ipinakilala ang benepisyo ng Community Health Worker para sa mga serbisyong pang-iwas noong Hulyo 1 para sa parehong Medi-Cal fee-for-service at mga sistema ng paghahatid ng pinamamahalaang pangangalaga.​​ 
• Tinaasan ang mga limitasyon ng asset ng pagiging karapat-dapat sa Medi-Cal sa $130,000 bawat tao at $65,000 bawat karagdagang tao upang makatulong na mapanatiling matatag sa pananalapi ang mga miyembro.​​ 
• Pinalawig na pagiging karapat-dapat para sa buong saklaw ng kalusugan sa mga taong 50 taong gulang at mas matanda, anuman ang katayuan sa imigrasyon, at gaya ng pinagtibay ng Senate Bill 184 (Kabanata 47, Mga Batas ng 2022), simula sa Enero 1, 2024, ang mga indibidwal na may edad 26 hanggang 49 ay magiging karapat-dapat para sa buong Medi-Cal.​​ 
• Pinalawak na pagpapatala ng pinamamahalaang pangangalaga ng Medi-Cal sa tinatayang 325,000 miyembro noong 2023 na parehong karapat-dapat para sa Medicare at Medi-Cal. Ang mga Medicare Medi-Cal Plan na ito ay idinisenyo upang i-coordinate ang mga benepisyo at pangangalaga, mga serbisyong medikal at tahanan at nakabatay sa komunidad, at mga medikal na supply at gamot.​​ 
• Reformed the financing of skilled nursing facilities, effective January 1, 2023, to better incentivize and hold facilities accountable for quality patient care and result in the long-term financial viability of facilities in Medi-Cal managed care. We are similarly developing the state’s new Alternative Payment Methodology for participating Federally Qualified Health Centers.​​ 

Pagsulong sa Kalusugan ng Pag-uugali​​ 

We made numerous investments to significantly expand capacity and address gaps within California’s behavioral health continuum.​​ 

CalAIM. CalAIM introduced new behavioral health policies to better meet the needs of Medi-Cal members with substance use disorder and mental health conditions, including:​​ 

• Pinahintulutan ang mga indibidwal na makatanggap ng mga serbisyo sa kalusugan ng pag-uugali nang walang diagnosis sa panahon ng pagtatasa.​​ 
• Pinasimple ang pamantayan para sa mga espesyal na serbisyo sa kalusugang pangkaisipan upang ang mga batang nakakaranas ng malaking trauma gaya ng kawalan ng tirahan o pagkakasangkot sa sistema ng kapakanan ng bata ay awtomatikong kwalipikado para sa mga espesyal na serbisyo sa kalusugan ng isip.​​ 
• Created a “no wrong door” policy to ensure individuals do not need to disrupt trusted relationships in one system when they need to receive care in another.​​ 
• Nakatanggap ng renewal para sa Drug Medi-Cal Organized Delivery System (DMC-ODS), bilang bahagi ng CalAIM, na ipinapatupad sa 37 county na sumasaklaw sa 96 porsiyento ng populasyon ng Medi-Cal. Kasama sa mga pagbabago sa patakaran ang:​​ 
  • Nagdagdag ng mga serbisyo ng Peer Support.​​ 
  • Inalis ang mga limitasyon sa residential treatment.​​ 
  • Pinalawak na access sa mga serbisyo sa pagbawi, kabilang ang para sa mga indibidwal na lumilipat mula sa pagkakakulong.​​ 
  • Launching DHCS’ contingency management pilot program in January 2023, which provides motivational incentives to reduce stimulant use disorders, and implement Medi-Cal covered mobile crisis services in county behavioral health programs.​​ 

California’s Master Plan for Kids’ Mental Health. In August, Governor Gavin Newsom unveiled California’s Master Plan for Kids’ Mental Health to ensure all California kids, parents, and communities have increased access to mental health and substance use services. The Children and Youth Behavioral Health Initiative (CYBHI) – approved by the Governor in 2021 – is a key component of the plan. CYBHI is a multiyear, multi-department package of investments totaling $4.7 billion that reimagines the systems that will improve access to behavioral health services for all children and youth in California, regardless of payer. Moreover, it will have significant implications for the Medi-Cal program, which covers 5.4 million children and youth.​​ 

Behavioral Health Continuum Infrastructure Program. To expand treatment resources, this year we awarded nearly a billion dollars in Behavioral Health Continuum Infrastructure Program (BHCIP) grant funds through the first four of six rounds of funding, with another $960 million to be awarded in future rounds. For more information on BHCIP grant funding and awards, please see the BHCIP Data Dashboard.​​ 

BHCIP represents the largest provision of resources for mental health and substance use disorder infrastructure in the state’s history, and an unprecedented opportunity to address historic gaps and make meaningful, sustainable change in California’s behavioral health continuum.​​ 

Other Important Achievements. Here are other notable DHCS achievements in behavioral health this year:​​ 

• Ginawang permanente ang telehealth, na tumutulong sa pagpapalawak ng access sa pangangalaga sa kalusugan ng pag-uugali.​​ 
• Nagbigay ng kritikal na suporta para sa Substance Abuse and Mental Health Services Administration 988 suicide at crisis-line website. Ang website ay isang one-stop na destinasyon na kinabibilangan ng toolkit para sa mga partner crisis call center, state mental health program, substance use treatment providers, behavioral health system, at iba pa.​​ 
• Ginawaran ng halos $106 milyon sa federal opioid response grants upang madagdagan ang access sa Medication-Assisted Treatment (MAT), bawasan ang hindi natugunan na pangangailangan sa paggamot, at bawasan ang opioid at fentanyl na overdose-related na pagkamatay sa pamamagitan ng pag-iwas, paggamot, at mga aktibidad sa pagbawi. Nakatuon ang mga proyektong ito sa mga populasyon at lugar na may limitadong pag-access sa MAT, kabilang ang mga kabataan, rural na lugar, at mga komunidad ng tribong American Indian at Alaska Native.​​ 
• Pinondohan ang 81 na departamentong pang-emergency sa pamamagitan ng CalBridge Behavioral Health Navigator Program upang palawakin ang mga manggagawa sa departamento ng emerhensiya upang matugunan ang agarang pangangailangan para sa pangangalaga sa kalusugan ng pag-uugali ng pasyente.​​ 

Patuloy na Pagtugon sa COVID-19 PHE​​ 

Mga Redeterminasyon ng Medi-Cal​​ . In March 2020, when the spread of COVID-19 triggered the PHE, the normal Medicaid eligibility process was suspended to ensure coverage for vulnerable individuals. According to a spending package recently passed by Congress and signed into law by President Biden, California would need to resume normal Medicaid eligibility redeterminations by April 1, 2023, which may result in millions of members losing their Medi-Cal coverage, even if the federal PHE has not ended. To mitigate this disruption to so many lives, DHCS launched the Coverage Ambassador program to educate all Medi-Cal members about how best to retain their health coverage. More broadly, all of our partners will play key roles in managing this process to minimize disruption to members.​​ 

PHE Unwinding Plan. In May, DHCS released the Medi-Cal COVID-19 PHE Operational Unwinding Plan describing our approach to unwinding or making permanent the temporary flexibilities implemented across the Medi-Cal program during the PHE and also our approach to resuming normal operations following the end of the PHE.​​ 

Health Care Workforce Retention Payments. Also, to stabilize and retain California’s health care workforce during the PHE, DHCS will issue more than a billion dollars in retention payments to workers in qualifying facilities and clinics during the first quarter of 2023.​​ 

Pagpapahusay ng Mga Operasyon ng Organisasyon​​ 

Tulad ng napakaraming lugar ng trabaho, ang DHCS ay ibang lugar na ngayon dahil sa pangako, katatagan, at pagbabago ng aming team na mabilis na kumikilos bilang tugon sa COVID-19. Iba ang ginagawa ng DHCS sa negosyo at nagpatupad ng teknolohiya, mga tool, at pagsasanay para sa isang pinakamainam, hybrid na organisasyon at workforce, kabilang ang paglipat ng karamihan sa mga empleyado sa telework. Tinitiyak namin na ang aming mga miyembro ng koponan ay mayroong kung ano ang kailangan nila upang patuloy na mapabuti ang paraan ng paghahatid namin ng mga serbisyo sa milyun-milyong taga-California.​​ 

Further, throughout 2022, our data team supported the analysis and development of new dashboards and data visualizations for telehealth, behavioral health, and long-term support services, among others.​​ 

Ang Kahalagahan ng ating Pagtutulungan​​ 

The Department’s mission to provide equitable access to affordable, integrated, high-quality health care is possible only with the engagement and contributions of our partners and stakeholders—all of you. This year we launched the DHCS Tribal Engagement Plan to provide opportunities for Tribal and Indian health representatives to be involved in developing Medi-Cal policies during quarterly meetings.​​ 

As we look ahead to 2023, we are excited to complete a statewide listening tour to hear from our partners; launch a Consumer Advisory Committee comprised of Medi-Cal members and family caregivers who will advise DHCS on new ways to improve Medi-Cal; and update our strategic plan to reflect our purpose and priorities.​​ 

In conclusion, on behalf of Team DHCS, I want to express our deepest gratitude to you for helping us build a healthy California for all. Wishing you a safe and healthy new year. Look forward to the opportunities together in 2023.​​ 

With gratitude,​​ 

Michelle​​