Medi-Cal成员咨询委员会会议纪要
日期： 16年 9 月， 2026
Time: 5:30 p.m. – 7:30 p.m. PDT
Type of Meeting: Virtual via Microsoft Teams
Members Present: 11 Medi-Cal Member Advisory Committee (MMAC) Members Present
DHCS Staff and Partners: Michelle Baass, Director; Tracy Arnold, Assistant Director; Chris Esguerra, MD, MBA, Chief Quality and Medical Officer and Deputy Director of Quality and Population Health Management; Shaun Garcia, Chief, Quality and Health Equity; Pam Riley, MD, MPH, Chief Health Equity Officer and Assistant Deputy Director, Quality and Population Health Management; Jamie Romas, Assistant Deputy Director, Office of Communications; Paula Wilhelm, Deputy Director, Behavioral Health; Eduardo Lozano, Stakeholder and Community Engagement Analyst; Maria Romero-Mora, Stakeholder and Community Engagement Analyst; Kiran Poonia, Stakeholder and Community Engagement Analyst; Isabel Flores, Stakeholder and Community Engagement Analyst; Evelyne Kane, Associate Director of Community Engagement and Capacity Building, Camden Coalition; Marisol Caban, Associate Director of Community Engagement and Capacity Building, Camden Coalition; Alexis Taylor, Founder & CEO, Taylor & Payne
补充信息：更多背景信息和详细信息，请参阅会议期间使用的PowerPoint 演示文稿。
Agenda:
| 时间 | 内容 |
|---|---|
| 5:30 - 6:00 | Welcome, Logistics, and MMAC Updates |
| 6:00 - 7:00 | DHCS Presentation: Making Medi-Cal Better: Helping People Get the Care They Need, When They Need It |
| 7:00 - 7:25 | 小组讨论和成员意见 |
| 7:25 - 7:30 | 结束语和下一步行动 |
Welcome and MMAC Updates
行动类型：信息
Presenters: Maria Romero-Mora and Michelle Baass
讨论主题
- 会议对 MMAC 成员表示欢迎，并回顾了语言公正和社区规范，以提醒与会者注意参与和参与做法。
- 参与者被要求披露任何利益冲突；没有发现任何利益冲突。
- DHCS welcomed four new staff members to the MMAC and invited all DHCS and MMAC members to introduce themselves.
- DHCS noted that member feedback for the unsatisfactory immigration status (UIS) to fee-for-service (FFS) transition was received and reviewed, and members would receive an email to vote on the set of recommendations tomorrow.
DHCS Presentation: Making Medi-Cal Better: Helping People Get the Care They Need, When They Need It
行动类型：信息
Presenter: Chris Esguerra
讨论主题
- DHCS provided an introduction to its value strategy and how DHCS is working to make Medi-Cal better by helping members get the care they need, when they need it.
- Policies and programs that are developed independently, often under tight deadlines, can create unnecessary work for providers, reduce the time providers spend with members, and encourage services that members may not need.
- DHCS is bringing its programs, policies, and payments into alignment to ensure they all work together to support providers in delivering timely care.
- The value strategy is DHCS’ plan to ensure Medi-Cal dollars are spent to help people get healthier and feel better, with value measured by member experience and health outcomes, not just cost.
- Member-centered areas of focus include:
- Access to care that is convenient, including appointments that are reasonably nearby and timely.
- Coordination among multiple providers and services, including the sharing and reviewing of member records.
- Prevention focused to help members stay healthy.
- Accountability, including measuring outcomes and experiences to determine if the approach is working.
- Efficient and appropriate use of the funds across the entire health care delivery system.
- DHCS described the goal as improving member health and wellness by delivering the right care, at the right time, in the right place, at the right cost. DHCS is being a good steward of taxpayer dollars to drive healthy outcomes.
- Making sure systems encourage certain behaviors.
- Scaling value-based payment includes attention to primary and maternity care, mental health services, hospitals, and skilled nursing facilities.
- DHCS clarified that the strategy is not about cutting costs by reducing rates or eliminating services, but about investing in areas that lead to better experiences and outcomes and correcting areas that do not.
- Bending the cost curve: not reducing funding, but using it prudently and effectively, tied to member health and well-being and improved outcomes
- MMAC members were invited to help co-design the value strategy by considering what is valuable to them and what could be better.
- Members were asked to reflect on their experiences with the health care system and to consider where they would invest $100 and cut $100.
- Members were invited to ask any questions before the group discussions.
分组讨论
Type of Action: Member Feedback
Facilitators: Maria Romero-Mora and Evelyne Kane
讨论主题
Members participated in two breakout rooms to discuss guiding questions. Each room moved through the questions at its own pace, so not all questions were discussed in both rooms. The feedback below includes what members shared across both rooms:
What are your immediate reactions to and questions about the presentation?
- One MMAC member expressed interest in the approach and asked what concrete steps DHCS would take to carry it out.
- One MMAC member expressed interest in the approach, but noted that the details of what providers are asked to do will determine if it works.
- MMAC members noted that the connection between what Medi-Cal pays for, hospitals, and the services members receive was new information for them, and that this connection is not widely understood by members.
- One MMAC member said that funding should be tied to accountability, including making sure members who call a provider or program are guided to the right place rather than just being told the office does not offer what they need.
- Two MMAC members recommended investing in training for all Medi-Cal staff, including front desk and intake staff, focused on sensitivity, diversity, and empathy, noting that the member experience begins at check-in and has a domino effect on the rest of the visit.
- MMAC members shared the common perception among Medi-Cal members that paying out of pocket would result in better care versus being on Medi-Cal.
- One MMAC member suggested that the presentation be adapted into a listening session so Medi-Cal members outside of the advisory group could hear about the value strategy and share feedback.
- MMAC members appreciated the focus on quality and improved outcomes rather than the quantity of services provided.
- One member raised three questions:
- Q1: What are providers saying about the shift to a value-based approach?
- DHCS shared that some providers may be resistant to the change and prefer how things currently operate. This resistance requires DHCS to consider which providers are best suited to partner with them. DHCS also noted that once providers understand the value of focusing more on outcomes, they are more likely to support the shift.
- Q2: How will providers be held accountable for delivering value and improving outcomes?
- DHCS explained that accountability could include looking at whether providers are improving health outcomes, as well as reviewing patient complaints and other member feedback.
- Q3: Will Medi-Cal be comparable with what other insurers offer providers (noting there are already areas lacking Medi-Cal providers, which may require members to travel further to seek and receive care)?
- DHCS acknowledged provider participation as a challenge and shared that the state is working to encourage more providers to participate. DHCS will support them through the transition.
- Q1: What are providers saying about the shift to a value-based approach?
- Several MMAC members asked about holistic health services, such as acupuncture and herbal supplements.
- One member asked if gym memberships are covered.
- DHCS explained that while physical fitness is not currently a covered benefit, Medi-Cal members may be able to access similar supports through community resources such as with the YMCA.
- One MMAC member highlighted the importance of making providers aware of available community partnerships so they know where they can refer members for services and supports that may not be directly covered.
When you think about your health, mental and physical, what is valuable to you?
- One MMAC member stated they valued knowing that a provider cares, even without a personal connection.
- MMAC members valued thorough care, including appropriate lab work and clear explanations of how to start, stop, or transition between medications, noting that members should not have to advocate for basic follow-up care or know in advance which questions to ask.
- One MMAC member raised the need for a backup plan for members who are placed on waiting lists or who cannot reach needed help, particularly during a mental health crisis, and asked what California is doing to provide equitable and accessible crisis resources.
- MMAC members expect quality, safe, respectful, and confidential care that addresses both their physical and mental health needs and to reduce crises, hospitalizations, and emergency visits.
- One MMAC member highlighted the value of care delivered in the home and asked that skilled nursing facilities be measured by the quality of discharge planning, including whether families are connected to In-Home Supportive Services, waivers, or CalAIM programs.
- One MMAC member described the lack of integration between mental health and physical health care, including the difficulty in moving between mild-to-moderate and specialty mental health services, inaccurate provider directories, and limited provider availability.
- MMAC members valued culturally relevant and culturally appropriate care and noted the difficulty of identifying providers who are familiar with or part of their culture. MMAC members noted that finding providers within their culture is almost always done by word-of-mouth referrals from other community members.
- MMAC members value freedom, independence, and sustainability, emphasizing the importance of maintaining health and well-being in the long-term and on their own terms.
- One MMAC member shared that his wheelchair frequently needs repairs and described challenges with obtaining a replacement. He identified two concerns: timely repairs to his existing wheelchair and the length of time required to receive a new wheelchair, identifying the wheelchair vendor, not his managed care plan, as the problem.
- One MMAC member shared they have experienced that differences in insurance coverage and payment can influence the care and services a patient receives.
- One MMAC member asked if payment codes could be more flexible for behavioral health and for the additional time and paperwork some visits require, noting this may encourage more providers to participate in Medi-Cal.
- One MMAC member asked that there be an appeal process for members who are in pain and are unable to access certain medications, noting the impact on underserved communities and members in recovery.
- DHCS shared that the Enhanced Care Management benefit under CalAIM is intended to help members navigate multiple delivery systems and offered to follow up individually with a member about this benefit.
- DHCS shared that 988 is available 24 hours a day, seven days a week, for mental health crisis support and can connect members to county and other providers.
- DHCS confirmed that members may ask a provider for a reasonable accommodation, such as additional appointment time, although providers may not always be able to meet requests.
What support do you need to get mental or medical care?
- One MMAC member suggested that plans and providers should take greater responsibility for helping members navigate care rather than placing the burden on members to figure out the process themselves, citing a positive experience with a liaison service through CalOptima that helped her navigate care.
- MMAC members stated they need a better understanding of the full range of programs and benefits available through their health coverage.
- MMAC members emphasized that culturally appropriate care from providers who speak their native language is essential to ensure quality, equitable access to health care.
Where would you invest $100 in the health care delivery system, and where would you cut $100?
- One MMAC member said they would invest in a whole-person and wraparound care modeled on the pediatric system, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) and California Children’s Services, and continue those supports as members age out of pediatric coverage
- One MMAC member said they would invest in accountability for referrals, provider directories, and the information members receive when they call for help.
- MMAC members said they would invest in sensitivity, diversity, and empathy training for all staff who interact with members, from the front desk through the clinical visit.
- One MMAC member said they would take funds away from providers that are not listening to and supporting members.
- One MMAC member said they would take funds away from online tools and applications that duplicate work, such as online check-in processes that still require members to complete paper forms and repeat their information. MMAC members noted that this question was difficult to answer. DHCS invited members to submit additional responses through the post-meeting survey.
成员意见
行动类型：讨论
演讲者玛丽亚-罗梅罗-莫拉
讨论主题
- Overall, MMAC members expressed gratitude to DHCS for holding this meeting.
- One MMAC member asked DHCS to consider turning the presentation into a listening session for Medi-Cal members outside of the advisory group.
- One MMAC member asked that meeting feedback be acted on quickly.
- One MMAC member expressed appreciation for a space that includes people working directly in the field alongside members.
- One MMAC member shared it was meaningful to discuss making Medi-Cal better rather than cutting Medi-Cal.
- One MMAC member expressed hope that 2027 will bring more actionable, equitable steps that improve member lives.
- MMAC members expressed gratitude for being heard and for the opportunity to hear one another’s experiences. They expressed hope that the changes discussed will make care more equitable and accessible.
闭幕词
行动类型：信息
演讲者米歇尔-巴斯
讨论主题
- Director Baass thanked members for their engagement and for being part of this collaborative space with Team DHCS.
- Director Baass reflected that member comments about provider empathy and listening speak directly to the value and quality of the health care experience, and that member emphasis on accountability aligns with DHCS’ commitment to using funding wisely.
- Members were encouraged to visit the Recommendations Tracker to stay up to date on the progress of MMAC recommendations.
- Members were reminded about the next meeting scheduled for November 18, 2026.
- Members were encouraged to visit the Medi-Cal Changes webpage to find information about the latest updates to the Medi-Cal program.
休会
宣布休会者姓名：米歇尔-巴斯
休会时间：太平洋夏令时晚上7:30