About Coverage

Health care coverage is necessary for Californians to live fruitful, productive lives and all should have coverage so they can access their health care system. As of 2021, about 93% of Californians had some kind of health insurance, and as of June 2023, about 15.6 million people were enrolled in Medi-Cal. Coverage opens the door to care for wellness, chronic disease, emergency needs, and life-threatening illnesses, and more must be done to ensure equitable access, especially for populations that have gone far too long without it.

Medicare Coverage for Behavioral Health Expanded

What’s happening: The Department of Health Care Services (DHCS) announced that Medicare will cover visits with mental health counselors, addiction counselors, and marriage and family therapists, effective since Jan. 1. 

What else to know: The Centers for Medicare & Medicaid Services (CMS) will conduct both routine and focused program audits of Medicare Advantage (MA) organizations in 2024 to assess compliance with new requirements. 

CMS Provides “Two-Midnight Rule” Guidance for Medicare Advantage Plans

What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a frequently asked questions (FAQ) document on finalized contract year 2024 Medicare Advantage (MA) policies.   

What else to know: The document provides guidance on how the “two-midnight” hospital admissions policies apply to MA patients when MA organizations are permitted to deny payment through post-claim audits. 

Major OHCA Developments to Track in 2024

What’s happening: OHCA ended 2023 with a proposed preliminary spending target of 3% annually for five years and it finalized cost and market impact review regulations.  

What else to know: OHCA’s policy development and implementation is expected to accelerate in 2024, specifically related to the adoption of an initial health care spending target.