加州努力扩大对受南加州山火影响的 Medi-Cal 会员的支持
一月17 ， 2025
SACRAMENTO — In response to the devastating Southern California wildfires and Governor Gavin Newsom’s proclaimed State of Emergency and Executive Order issued on January 7, 2025, the Department of Health Care Services (DHCS) swiftly implemented key administrative flexibilities to protect Medi-Cal members in affected regions of the state. These efforts include simplified Medi-Cal enrollment and renewal processes, waived requirements to access prescription medications and medical devices, and other flexibilities to ensure all Medi-Cal members have access to care during this emergency.
Help for Medi-Cal members in Los Angeles County and Ventura County includes:
- Simple renewal and enrollment: Simplified Medi-Cal enrollment and renewal processes to allow families to quickly secure or maintain Medi-Cal coverage. Allowed for self-attestation for residency and income if documentation is missing, and verification deadlines are extended. Local county offices are prioritizing Medi-Cal applications and any case restorations for affected Medi-Cal members, who are encouraged to contact their local clinic navigators or local county office if assistance is needed to resolve eligibility issues.
- Fast refills for pharmacy and medical equipment: Waived prescription signature requirements for Medi-Cal members. Released a provider alert to allow for early refill authorizations and emergency override of existing utilization management and prior authorization controls to facilitate expedited access to medications and pharmacy products to ensure timely care.
- Prioritized member transfers if moving out of Los Angeles or Ventura counties: Medi-Cal members who are displaced for an unknown amount of time may contact either their former county of residence or the new county to assist with transferring the case on a permanent or short-term basis. Members can visit the DHCS website to find their local county office.
- Emergency response protocols: Medi-Cal managed care plans that operate in the areas subject to the emergency, including L.A. Care Health Plan, Health Net, Molina Healthcare, Gold Coast Health Plan, Kaiser Permanente, Anthem, Blue Shield of California Promise Health Plan, Senior Care Action Network, and Positive Healthcare California (AIDS Healthcare Foundation), have activated their emergency response protocols. Protocols include deploying care management teams to conduct member outreach, especially for high needs populations; waiving prior authorization requirements; working to provide transportation to care; and ensuring members do not face any out-of-pocket costs for getting care from out-of-network providers, as needed.
DHCS understands recovering from these wildfires will be challenging and has developed an online resource to help answer Medi-Cal member questions about accessing services during this emergency.
Current flexibilities for Medi-Cal managed care plans and providers include:
- Behavioral health services: Ensured relocated clients from evacuated facilities receive continuous care, with licensing and certification flexibilities supporting affected treatment programs.
- Provider support: Extended reporting and administrative deadlines, enabling Medi-Cal providers to prioritize care delivery until the end of the emergency.
- Managed care flexibility: Waived prior authorizations and referral requirements for applicable services to help Medi-Cal managed care plans and their network providers deliver timely care to members affected by evacuations and service disruptions.
Additionally, DHCS submitted requests to the federal Centers for Medicare & Medicaid Services (CMS) to help Californians covered by Medi-Cal impacted by the Southern California wildfires. Section 1135 of the Social Security Act provides flexibility during national public health emergencies.
“At DHCS, our members are our top priority, and our hearts go out to the families affected by the Southern California wildfires,” said DHCS Director Michelle Baass. “We are working closely with CMS to obtain speedy federal approvals for flexibilities to help our state and Medi-Cal members meet the challenges posed by the wildfires. We will continue to issue guidance to providers so they can quickly take advantage of the new flexibilities to deliver quality, equitable health care to Southern Californian Medi-Cal members.”
Significant additional flexibilities requested by DHCS include:
- 对诊所和设施的支持：
- 当主要设施受损或无法进入时，允许诊所在流动诊所或临时地点等替代环境中提供医疗服务。
- 授权全额报销临时护理机构（包括庇护所和酒店）提供的服务的费用。
- Medi-Cal 会员的额外保护：
- 延长公平听证请求和福利恢复的时间，让 Medi-Cal 会员有更多时间解决资格或福利问题。
- 调整家庭保健服务要求，以允许由于当前限制而延迟面对面的接触。
- Medi-Cal 提供商注册和报销：
- 加快并简化提供商注册流程，使提供商更容易为受影响的成员提供护理。
- 长期服务和支持（LTSS）的灵活性：
- 延长初步评估、重新评估和护理计划审查的时间，以确保因年龄、残疾或慢性疾病而需要持续支持的个人得到不间断的护理。
- 允许在其他地点（例如避难所或酒店）提供 LTSS。
- 报告和声明要求的扩展：
- 延长数据报告和索赔提交期限，使受影响的当地机构和教育机构能够按时完成任务。
- 允许健康计划在满足报告要求方面有更大的灵活性，以确保如果野火扰乱了正常运营，他们能够继续为会员提供服务。 调整包括调整会员需要行驶多远距离接受护理以及多快能够获得 LTSS 的规则。
DHCS is dedicated to safeguarding the health and well-being of Medi-Cal members and communities suffering from the devastating effects of the Southern California wildfires. DHCS’ purpose extends beyond routine health care services, focusing on proactive planning, rapid response, and continuous support in the face of challenges like these wildfires.
通过与州、地方、联邦和部落合作伙伴的协调努力，DHCS 确保受影响的个人能够及时获得重要的医疗服务。 DHCS 利用其团队的专业知识和紧急法规的灵活性来满足南加州社区的独特需求，从促进获得医疗保健和行为健康服务到确保药品和耐用医疗设备的可用性。
BACKGROUND: On January 8, 2025, in response to the catastrophic wildfires in Southern California, President Joseph R. Biden, Jr. declared that a major disaster exists in the State of California in the areas affected by wildfires. On January 10, 2025, U.S. Department of Health & Human Services Secretary Xavier Becerra declared a public health emergency for California, granting CMS additional flexibility to address the health needs of impacted individuals. These measures were made possible through extensive preparedness planning and proactive emergency response protocols. These efforts underscore a strong state and federal partnership, ensuring uninterrupted care and services during this emergency.
DHCS administers Medi-Cal, California’s version of Medicaid, providing health coverage to nearly 15 million people, including nearly 4 million members in Los Angeles County and more than 250,000 members in Ventura County.
DHCS encourages all affected residents to follow local evacuation orders, monitor air quality, and wear masks outdoors, if needed. If Medi-Cal members need assistance, they should contact their health care provider or plan.
更多信息：以下链接提供资源和更新：
- DHCS 南加州火灾响应
- DHCS 紧急和灾难援助信息常见问题解答
- 加州卫生与公众服务局紧急资源指南
- 加州老龄部门应急准备指南
- CalHOPE 热线和心理健康支持
- Medi-Cal 会员援助
- 加州移民灾难援助服务指南（英语/西班牙语）
- 当地县级办事处名录
- 诊所健康登记导航器
- BenefitsCal ：Medi-Cal 会员可以访问 BenefitsCal 来更新联系信息。
立即获取帮助：
- Californians can visit CA.gov/LAfires, a hub for information and resources from state, local, and federal governments.
- 因山火遭受损失的个人和企业主可以申请灾难援助：
- 请访问DisasterAssistance.gov在线访问。
- 拨打 800-621-3362。
- 通过使用联邦紧急事务管理局 (FEMA) 智能手机应用程序。
- 我们提供超过40 种语言的帮助。
- 如果您使用中继服务，例如视频中继服务、带字幕的电话服务或其他服务，请向 FEMA 提供该服务的号码。
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接触：
Office of Communications
(916) 440-7660
www.dhcs.ca.gov