Medi-Cal

About Medi-Cal

Every year, California’s hospitals treat millions of patients, many of them covered by Medi-Cal, the state’s health care safety net. This includes numerous essential health care services, including care for more than 50% of all births, 51% of behavioral health-related emergency department visits, and 49% of rural hospital patient care But for low-income Californians who rely on Medi-Cal for coverage — two-thirds of whom are people of color — their care is at serious risk. Communities with high Medi-Cal enrollment already suffer from a severe lack of health care providers and with hospital services at risk of being reduced and outright closures looming, California’s most vulnerable, including people living in rural and underserved areas, are in jeopardy.

DHCS Updating Payment System for Diagnosis-Related Group Reimbursement

On Sept. 23, the Department of Health Care Services (DHCS) announced it is updating the Medi-Cal payment system for diagnosis-related group (DRG) reimbursement with the newest ICD-10 diagnosis and surgical procedure codes released by the Centers for Medicare & Medicaid Services, effective for dates of service on or after Oct. 1. However, system updates will […]

DHCS Releases Private Hospital-Directed Payment Encounter Files 

On Sept. 9, 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 […]

State Budget Takes a Wide Variety of Health Care-Related Actions 

In June 2022, the Legislature and governor approved a $308 billion budget for the state fiscal year spanning from July 2022 through June 2023. In late August, the Legislature passed and the governor is expected to approve revisions to the 2022-23 Budget Act, which generally redirect, build upon, or provide statutory parameters around actions previously […]

DHCS Adds New COVID-19-Related Codes to the Diagnosis-Related Group Methodology, Retroactively to April 1

The Department of Health Care Services (DHCS) recently announced the incorporation of new Centers for Medicare & Medicaid Services-approved ICD-10-CM and ICD-10-PCS codes related to COVID-19 into the diagnosis-related group inpatient hospital payment methodology, retroactively to April 1.    The following diagnosis and procedure codes will now be reflected in the methodology of determining a hospital’s […]