Medi-Cal

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.

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.  

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

DHCS Scheduled to Release Medi-Cal Managed Care Utilization Data to Health Plans and Hospitals

What’s happening: On March 8, the California Department of Health Care Services (DHCS) released the latest round of Medi-Cal managed care utilization data to hospitals and health plans. These data are used to determine the amount of funding each hospital will receive in the Private Hospital Directed Payment Program.   

What else to know: Hospitals should download their data from the DHCS secure site as soon as possible because uploaded files will be deleted within 45 days. Hospitals should compare these data to their own utilization records and work with their contracted Medi-Cal managed care plans to reconcile any differences in order to get full credit and payment for contracted services provided during the program period. Medi-Cal managed care plans have approximately five weeks to return the data to DHCS. The uploaded files cover the following service periods: 

CHA Participates in DHCS Population Health Management Summit

What’s happening: CHA recently participated in the Population Health Management Transitional Care Services Summit hosted by the Department of Health Care Services. 

What else to know: The summit provided an opportunity for Medi-Cal Managed Care leaders to provide updates on the implementation of transitional care services and share best practices. Several panels included representatives from CHA member hospitals, including Watsonville Community Hospital, Dignity Health, and the University of California, San Francisco.