About Medi-Cal
More than 15 million Californians rely on Medi-Cal, the state’s health care coverage safety net, for health insurance. Two-thirds of those on Medi-Cal are people of color and often live in communities with a lack of adequate health care providers. Without significant investments to support providers that deliver health care to California’s most vulnerable, millions living in rural and underserved areas are in jeopardy.
DHCS Issues Final Concept Paper on Medi-Cal Waiver
The Department of Health Care Services (DHCS) has revised and published a document outlining the state’s concept for a Medi-Cal waiver that would go into effect Sept. 1, replacing the state’s current waiver for hospital financing and uninsured care that expires Aug. 31.
Ballot Initiative Would Dedicate MCO Tax Revenue to Fund Medi-Cal
What’s happening: The Coalition to Protect Access to Care has submitted more than 800,000 voter signatures to qualify the Protect Access to Healthcare initiative for California’s November 2024 ballot.
What else to know: CHA supports the proposed ballot measure, which would permanently channel managed care organization (MCO) tax revenue to Medi-Cal providers such as hospitals, physicians, women’s health and community clinics, and health centers.
CMS Finalizes Medicaid Managed Care Rule on Access, Finance, and Quality
What’s happening: The Centers for Medicare & Medicaid Services (CMS) finalized the Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality rule.
What else to know: The rule finalizes significant changes and clarifications regarding managed care delivery and finance.
Hospital Leaders Discuss Financial Challenges with Legislators on Capitol Hill
What’s happening: Last week, California hospital and health system leaders convened in Washington, D.C. for the American Hospital Association (AHA) Annual Membership Meeting.
What else to know: Hospital and health system leaders participated in meetings on Capitol Hill with the California congressional delegation to advance CHA’s position on key advocacy priorities.
Mastering Medi-Cal Managed Care Webinar Set for Jan. 30
Over the past two years, the Medi-Cal program has grown significantly and now serves approximately one-third of Californians, with nearly 80 percent enrollment in managed care. This rapid expansion has meant a large transition for particularly vulnerable populations, including seniors, people with disabilities and low-income families. This shift has also affected hospitals as they attempt to coordinate benefits and ensure Medi-Cal patients are receiving the right care, at the right place and the right time, and that Medi-Cal managed care plans meet their obligations in managing care for millions of Californians.
To help members better understand Medi-Cal managed care, CHA will host a webinar Jan. 30 from 10 a.m. – noon (PT). Chief operating officers, chief financial officers, clinical operations executives, case management directors, legal counsel and finance staff should plan to participate in this webinar. The program will begin with a background of Medi-Cal managed care, followed by top tips for contracting and working with Medi-Cal managed care plans. For more information and to register, visit www.calhospital.org/medi-cal-managed-care-web.
Panel Explores Reasons for Hospital Maternity Ward Closures
What’s happening: The closure of labor and delivery units in California hospitals was the focus of a recent panel discussion sponsored by the nonprofit news organization CalMatters. Peggy Wheeler, CHA vice president, policy, appeared on the panel.
What else to know: The discussion “No Deliveries: When Maternity Wards Close, Where Do Patients Go?” focused on the pace and impact of maternity unit closures and efforts to protect access. Wheeler shared the reasons underlying these closures, including low birth rates, workforce challenges, and insufficient Medi-Cal reimbursement rates.
Tyler Sadwith Appointed as DHCS State Medicaid Director
What’s happening: On March 13, Gov. Newsom announced the appointment of Tyler Sadwith as state Medicaid director at the Department of Health Care Services (DHCS), effective March 25.
What else to know: Sadwith has held leadership positions at DHCS since July 2021, most recently serving as deputy director for behavioral health since June 2022.
Providers Must Register for New Medi-Cal Portal by April 11
What’s happening: The Department of Health Care Services (DHCS) will be decommissioning the legacy portal for presumptive eligibility (PE) enrollment and replacing it with the new Medi-Cal Provider Portal.
What else to know: Providers who currently use the legacy Medi-Cal Transaction Services Portal must register for the new Medi-Cal Provider Portal by April 11. Failure to register will result in losing access to the PE applications.
DHCS Issues Memo to Medi-Cal Managed Care Health Plans on Change Healthcare Cyberattack
What’s happening: On March 13, the Department of Health Care Services issued a memo to its contracted Medi-Cal managed care plans (MCPs) related to flexibilities to ensure delivery system stability following the Change Healthcare cyberattack.
What else to know: The memo reminds MCPs of their claims payment contractual responsibilities, including oversight of their delegated entities, and strongly encourages MCPs to take steps to support the provider community.
Medi-Cal Managed Care Plans Receive Private Hospital Directed Payment Funding
What’s happening: During the week of Feb. 26, Medi-Cal managed care plans received the funds related to Hospital Fee Program 7, Private Hospital Directed Payment (PHDP) Cycle 1. In January, hospitals and Medi-Cal managed care plans also received their payment schedules, which detail the amount each health plan is directed to pay and to which hospitals.
What else to know: Health plans are required to make these payments to hospitals within 30 days of receipt of the funds. Hospitals that have not yet received their PHDP funds should reach out to their health plans for a status update. Hospitals that still have not received the PHDP funding by the end of March should contact Robert Ducay, vice president, policy, at rducay@calhospital.org.