Mayo 27, 2025
Nangungunang Balita
Sinusuportahan ng Bagong Ulat sa Mga Serbisyong Pangkalusugan ng Pag-uugali (BHSA) ang Katatagan at Pagpaplano ng Kita
DHCS released the BHSA Revenue Stability Workgroup Report with recommendations to reduce the variance of county Behavioral Health Services Funds (BHSF). The recommendations are intended to help counties manage revenue more consistently, maintain services through economic ups and downs, and bring greater predictability and accountability to local behavioral health care funding.
The BHSA Revenue Stability Workgroup, comprising state leaders and counties, was required to develop and recommend solutions to reduce BHSA revenue volatility and propose appropriate prudent reserve levels to support the sustainability of county programs and services. It reviewed and analyzed current and historical revenues generated by the MHSA and the BHSA and prudent reserve levels to develop the recommendations.
The State Controller’s Office will continue to follow the current process to distribute BHSA local assistance funds to counties monthly. The goal is to balance local assistance revenue allocation and program stability, helping counties effectively plan and provide critical behavioral health services during revenue downturns. Highlights include:
- Taunang mga palapag ng paggasta batay sa isang tatlong-taong average, isinaayos para sa inflation.
- Mga bagong limitasyon sa reserba (10-15 porsiyento, depende sa laki ng county).
- Isang beses na kinakailangan upang gumastos ng mga labis na reserba sa pagitan ng 2026–2029.
- Kakayahang umangkop upang ayusin ang mga badyet kung bumaba ang mga kita.
- Higit na transparency, na may kinakailangang pampublikong pag-uulat at input ng komunidad.
This approach supports California’s Mental Health for All vision by promoting stability, transparency, and community-centered behavioral health care. State legislation is required to enact recommendations from the BHSA Revenue Stability Workgroup Report.
Sinusuportahan ng Komunidad ang Pagpapakita ng Maagang Pagkakabisa sa Gastos Habang Tinutugunan ang Mga Pangangailangan ng Miyembro ng Medi-Cal
DHCS recently submitted to the Centers for Medicare & Medicaid Services (CMS) its Community Supports, or In Lieu of Services (ILOS), Annual Report[TO1] , which reviews the progress and impact of Medi-Cal Community Supports in 2024. For the first time, the report also includes a cost-effectiveness analysis for 2023. The report highlights key achievements, such as reduced emergency room visits, hospitalizations, and long-term care use, pointing to early evidence of both improved health outcomes and reduced costs when compared to the services they are replacing, such as inpatient, emergency department, and long-term care services. Of the 12 Community Supports studied, nine are already proving cost-effective, and the remaining three are expected to prove to be cost-effective over time.
The report also outlines operational improvements made by DHCS and managed care plans (MCP) to expand services, grow provider networks, and support implementation. While progress has been significant, the report also identifies ongoing challenges and opportunities for further improvement, ensuring these services continue to evolve to meet the needs of Medi-Cal members.
Mga Update sa Programa
Medi-Cal Commercial MCP Procurement Update
Ipagpapaliban ng DHCS ang susunod na komersyal na pagkuha ng Medi-Cal MCP nang hindi bababa sa dalawang taon. Ang susunod na mapagkumpitensyang pagkuha para sa mga MCP ay magsisimula nang hindi mas maaga sa 2029, at ang mga kontrata ay inaasahang magkakabisa nang hindi mas maaga sa 2031. Nauna nang ipinahiwatig ng DHCS na ang muling pagkuha para sa mga komersyal na MCP ay isasagawa kada limang taon. Sa ilalim ng ipinapalagay na timeline na ito, kinailangan sanang ilabas ng DHCS ang Request for Proposal (RFP) noong 2027 para sa isang petsa ng pagiging epektibo ng kontrata sa Enero 1, 2029.
The additional time will allow DHCS to focus on critical California Advancing and Innovating Medi-Cal (CalAIM) initiatives. It will also help maintain stability for members and support ongoing improvements to care quality and access, while also supporting the long-term success of the Medi-Cal managed care program.
In accordance with current policy, MCP contracts will be renewed annually following the contractual requirements identified in Exhibit E, 1.1.15 of the 2024 Managed Care Boilerplate Contract. Current MCP contracts will be extended from January 1, 2026, to December 31, 2026, by the established annual process. DHCS remains committed to fostering an inclusive, flexible, and responsive process that supports the Medi-Cal program and ensures continued equitable access to high-quality care for Californians. Please visit the Medi-Cal Managed Care webpage for more information.
Dental Managed Care Transition
During the week of May 26, DHCS will mail a 30-day notice to about 350,000 Medi-Cal members in Sacramento and Los Angeles counties to notify them of upcoming changes to their dental service delivery, effective July 1, 2025. The member notice explains what is changing, if the member needs to make a plan choice, the member’s continuity of care protections, and other important information, and will include a Medi-Cal managed care enrollment packet.
Members in Sacramento County who are currently enrolled in Access Dental Plan or dental fee-for-service (FFS) must select a new Dental Managed Care plan, while members in Los Angeles County who do not choose a Dental Managed Care plan will remain in FFS. Members currently enrolled with Health Net or Liberty will not be affected by these changes. Additionally, changing Dental Managed Care plans will not affect Medi-Cal coverage or benefits.
Ang Medi-Cal Health Care Options ay nagsasagawa ng isang kampanya ng outbound call sa mga miyembrong nakatanggap ng isang managed care enrollment packet. Sa mga tawag na ito, susuriin ng mga kinatawan ng HCO ang mga available na pagpipilian sa plano ng Dental Managed Care, sasagutin ang mga tanong, at padadaliin ang pagpapatala sa napiling plano ng miyembro sa pamamagitan ng telepono. Binuo ng DHCS ang webpage na Dental Transition Member Notices para makita ng mga miyembro ang mga abiso at iba pang impormasyon tungkol sa transisyon sa Dental Managed Care.
Mga Kinakailangan at Pamamaraan sa Pagpapatala ng Medi-Cal para sa Mga Provider ng Parmasya
Simula Agosto 1, 2025, ang mga tagapagbigay ng parmasya na may hawak na balidong Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver at kasalukuyang Certificate of California Clinical Laboratory Registration ay maaaring maningil para sa mga pagsusuring hindi sakop ng CLIA na ibinigay sa loob ng saklaw ng pagsasagawa ng parmasyutiko gaya ng tinukoy ng California State Board of Pharmacy at awtorisado sa Business and Professions Code Section 4052.4. Ang mga tagapagbigay ng parmasya ay dapat mag-aplay upang magpatala sa Program Medi-Cal sa pamamagitan ng pagsusumite ng online na aplikasyon sa pagpapatala para sa tagapagbigay ng Medi-Cal , kasama ang lahat ng sumusuportang dokumento.
On June 10, from 10 to 11 a.m. PDT, DHCS will hold a public stakeholder hearing via webinar (advance registration required) to discuss the draft regulatory provider bulletin entitled, “Medi-Cal Enrollment Requirements and Procedures for Pharmacy Providers that Hold a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver.”
Written comments, questions, or suggestions may be submitted during the hearing in the webinar chat. For those unable to attend, written comments must be submitted by 5 p.m. PDT on June 10 to be considered for publication. When submitting written comments, please ensure that the commenter and organization/association being represented are both identified in the comments. Please submit written comments to DHCSPEDStakeholder@dhcs.ca.gov. Based on the public comments received, DHCS will publish the final bulletin on the Medi-Cal providers and DHCS Provider Enrollment Division websites.
Sumali sa Aming Koponan
Ang DHCS ay naghahanap ng isang may talento at motibasyon na indibidwal na maglingkod bilang:
- Chief, Capitated Rates Development Division. Pinamunuan ng Hepe ang mga aktibidad sa pagtatakda ng rate para sa mga plano sa pangangalagang pinamamahalaan ng Medi-Cal at Mga Programa ng All-Inclusive na Pangangalaga para sa mga organisasyon ng matatanda. Kasama sa mga aktibidad ang pagpapatupad ng mga actuarial na pamamaraan para sa pagtatatag ng mga rate ng capitation at pangangasiwa sa pagbuo at pagpapatupad ng mga patakaran at protocol para sa mga reimbursement. Bukod pa rito, tinitiyak ng Hepe na ang mga pamamaraan sa pananalapi ay naaayon sa mahusay na paghahatid ng de-kalidad na pangangalagang pangkalusugan at sumusunod sa mga batas, regulasyon, at tuntunin ng estado at pederal. Dapat isumite ang mga aplikasyon bago ang Mayo 30.
- Assistant Deputy Director (ADD), Enterprise Technology Services (ETS). This new ADD role will build collaborative working relationships with DHCS Executive Staff, program partners, and external stakeholders, and assist with leading DHCS’ IT programs and services. Additionally, the ADD will play a vital role in leading the development and implementation of IT policies, system architecture, security, improvements, and solutions for DHCS programs, including Medi-Cal and behavioral health. Applications must be submitted by June 2.
Naghahanap DHCS ng mga empleyado para sa Medi-Cal Managed Care, data analytics, Medi-Cal eligibility, at iba pang mga team nito. Para sa karagdagang impormasyon, pakibisita ang website ng CalCareers.
Mga Paparating na Mga Pagpupulong ng Stakeholder at Webinar
DHCS posts upcoming public meetings on the Calendar of Events. DHCS provides free assistive services, including language interpretation, real-time captioning, and alternate formatting of meeting materials. To request services, please email DHCS at the appropriate contact email address at least ten working days before the meeting.
Serye ng Webinar ng Coverage Ambassador: Birthing Care Pathway
On May 29, from 11 a.m. to 12 p.m. PDT, DHCS will hold a Coverage Ambassador webinar that will focus on DHCS’ Birthing Care Pathway initiative (advance registration required). The webinar will provide information about maternity services for pregnant and postpartum Medi-Cal members from conception through 12 months postpartum and review highlights from the Birthing Care Pathway Report released on February 4. This initiative helps to ensure Medi-Cal members have access to high-quality, equitable care to improve maternal health outcomes and reduce disparities. Coverage Ambassadors will also learn about DHCS’ social media platforms, which offer up-to-date information on relevant topics that can benefit both Coverage Ambassadors and Medi-Cal members. Simultaneous interpretation in Spanish will be offered during the webinar.
Kung sakaling Nalampasan Mo Ito
Kahilingan para sa mga Aplikasyon (RFA): Flexible Housing Subsidy Pool
On May 7, DHCS announced the Flexible Housing Subsidy Pools (“Flex Pools”) RFA. DHCS will select up to 10 local teams to participate in the Flex Pools TA Academy and receive Flex Pools planning grants of approximately $150,000. The launch of Medi-Cal Transitional Rent and Behavioral Health Services Act (BHSA) Housing Interventions creates an unprecedented opportunity to help people achieve better health outcomes through housing stability.
Flex Pools are intended to help counties and Tribal entities improve housing stability for individuals experiencing or at risk of homelessness. They are a locally designed model to coordinate rental assistance and make the best use of available housing supports, aligning the work of managed care plans, county behavioral health agencies, and other key partners in the homeless services and rehousing systems. Applications are due to DHCS by 5 p.m. PDT on June 13, 2025. Organizations selected will be notified in July 2025. To learn more and apply, please visit the DHCS Housing for Health website.
Aplikasyon sa Pag-amyenda ng HCBA Waiver – 30-Araw na Panahon ng Pampublikong Komento
Noong Mayo 12, nag-post ang DHCS ng draft ng susog sa 2025 Home and Community-Based Alternatives (HCBA) waiver para sa 30-araw na panahon ng pampublikong komento, bago isumite ang pinal na bersyon sa CMS para sa muling awtorisasyon. Ang waiver ng HCBA ay nagpapahintulot sa mga kwalipikadong enrollee na makatanggap ng mga aprubadong serbisyo sa pamamagitan ng Telehealth delivery system. Kabilang sa mga iminungkahing pagbabago sa susog sa waiver ang:
- Paglilinaw ng patnubay at mga inaasahan para sa mga serbisyo ng telehealth.
- Pag-aalis ng Intermediate Care Facilities para sa Developmentally Disabled–Continuous Nursing (ICF/DD-CN) na benepisyo at mga setting na hindi naka-vent at nakadepende sa vent, dahil ang mga ito ay inililipat sa Medicaid State Plan bilang mga benepisyo sa pangmatagalang pangangalaga.
This transition advances California’s efforts to comply with the federal Medicaid Home and Community-Based Settings (HCBS) Final Rule by reinforcing the delivery of services in integrated, community-based settings that support individual choice and autonomy.
DHCS invites all interested parties to review the amendments and comment instructions on the DHCS HCBA Waiver webpage under the HCBA Waiver Amendment Application – 30-Day Public Comment from May 12, 2025 – June 12, 2025 heading. All comments must be received by June 12, 2025. If you have any questions, please email hcbspolicy@dhcs.ca.gov.
Medicaid State Plan Amendment (SPA) – 30-Araw na Panahon ng Pampublikong Komento
On May 12, DHCS posted the ICF/DD-CN: Transition of Benefit/Setting SPA (SPA #25-0026) for a 30-day public comment period, prior to submitting the final version to CMS for approval. ICF/DD-CNs provide 24-hour personal care, developmental services, and nursing supervision for individuals with developmental disabilities who have continuous needs for skilled nursing care and have been certified by a physician and surgeon as warranting continuous skilled nursing care. This service is currently provided through the HCBA waiver. This SPA will transition the ICF/DD-CN benefit/setting from the HCBA waiver to the Medicaid State Plan as a long-term care setting. This transition advances California’s efforts to comply with the federal HCBS Final Rule by reinforcing the delivery of services in integrated, community-based settings that support individual choice and autonomy. All comments must be received by June 12, 2025. If you have any questions, please email PublicInput@dhcs.ca.gov.