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.
Diagnosis-Related Group Program Updates Medi-Cal FFS Payment System
On Oct. 3, the Department of Health Care Services notified hospital providers that the diagnosis-related group (DRG) program has updated the Medi-Cal fee-for-service (FFS) payment system with the newest ICD-10-CM diagnosis and surgical procedure codes released by the Centers for Medicare & Medicaid Services, effective on or after Oct. 1, 2023.
DHCS Issues Updated 2024 Medi-Cal Managed Care Plan Transition Policy Guide
On Sept. 29, the Department of Health Care Services (DHCS) released an updated 2024 Medi-Cal Managed Care Plan (MCP) Transition Policy Guide. It includes the new MCP Transition Monitoring and Oversight Policy and new transition-related requirements for incentive programs, as well as updates to all other sections of the policy guide. It also contains DHCS policy and related MCP requirements related to member transitions among Medi-Cal MCPs that take effect on Jan. 1, 2024.
Federal Government Shutdown Averted, Temporary Continuing Resolution Passed
On Sept. 30, Congress passed, and President Biden signed a continuing resolution (CR) funding the federal government for 45 days. The measure includes a 45-day delay of the Medicaid disproportionate share hospital cuts, as well as $16 billion in Federal Emergency Management Agency funding for disaster relief as requested by the White House.
Essential Information for Hospitals as Federal Shutdown Looms
Barring any last-minute actions, Congress appears unable to prevent a shutdown of the federal government on Sept. 30.
CHA Gets Behind Measure to Secure Resources for Medi-Cal Providers
Earlier this month, CHA joined a broad group of doctors, dentists, health plans, community health centers, and other health care groups to file a statewide ballot measure that aims to build on the historic investment that the governor and Legislature made earlier this year to provide greater support to Medi-Cal patients.
CMS Approves Medi-Cal Managed Care Rates for Jan. 1-Dec. 31, 2021
On Sept. 11, the Centers for Medicare & Medicaid Services (CMS) approved the Medi-Cal managed care rates for Jan. 1-Dec. 31, 2021. Subsequently, on Sept. 14, CMS approved the revised rate packages for Jan. 1-Dec. 31, 2021.
Federal Government Shutdown Anticipated
Congress must act to continue funding for the federal government and avoid a shutdown before the end of the federal fiscal year on Sept. 30. However, given the limited progress in drafting appropriations legislation and resistance to passing a continuing resolution by some members of Congress, the likelihood of a federal government shutdown is growing. It is anticipated that when a continuing resolution is passed, it will be short-term.
DHCS Releases Private Hospital-Directed Payment Encounter Files
On Sept. 8, the Department of Health Care Services (DHCS) uploaded three new hospital-directed payment encounter files, available via the Secure File Transfer Protocol site. It is important for hospitals to download these files as soon as possible as the site is only intended for file transfers, not ongoing storage, and uploaded files will be deleted within 45 days.
2024 Statewide Ballot Measure Could Bring Significant Annual Funding to Health Care
The Coalition to Protect Access to Care — a broad and diverse group of doctors, dentists, community health centers, hospitals, including CHA, Planned Parenthood, emergency responders, health plans, and health care workers — this week filed a statewide ballot measure with the California Attorney General’s office with the goal of qualifying the measure for the November 2024 ballot.
Hospitals Remain on Uncertain Footing
Over the summer, the country’s hospitals — struggling to get back on their feet following the crippling revenue losses from the COVID-19 pandemic, skyrocketing inflation, and stagnant government funding — suffered yet another setback. According to the August “National Hospital Flash Report” from national health care consulting firm Kaufman Hall, operating margins dipped in July to a meager 1.3% (for comparison, insurance companies were above 15% in 2023).