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.
CHA Continues Support for Medicaid DSH
What’s happening: Current funding legislation supported by CHA extends the delay in the implementation of pending Medicaid disproportionate share hospital cuts until March 8.
What else to know: On Jan. 18, the House and Senate passed legislation, known as a continuing resolution, to fund the federal government though March 1 for certain departments, and March 8 for others.
Summary: Finalized Interoperability and Prior Authorization Policies
What’s happening: A members-only summary of finalized interoperability and prior authorization processes is available.
What else to know: The final rule is scheduled for publication in the Feb. 8 issue of the Federal Register.
CHA Analysis: Proposed MCO Tax Spending Plan Maintains Key State Commitment
What’s happening: On Jan. 20, the California Department of Health Care Services (DHCS) published its spending plan on how the Newsom administration proposes to spend almost $2.7 billion in annual managed care organization (MCO) tax funds to improve Medi-Cal reimbursements.
What else to know: CHA expects the proposal to be refined and finalized by July 2024 and implemented starting in 2025.
Congress Passes Legislation to Fund Government Through March
What’s happening: On Jan. 18, the House and Senate passed legislation, known as a continuing resolution, to fund the federal government though March 1 for certain departments and March 8 for others. President Joe Biden signed the bill on Jan. 19.
What else to know: The resolution included a CHA-supported provision to delay scheduled Medicaid disproportionate share hospital cuts until March 8.
New Federal Electronic Prior Authorization Requirements Finalized
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has finalized policies to advance interoperability and streamline prior authorization processes by using application programming interfaces (API) technology.
What else to know: The final rule also requires payers to provide a specific reason for denied prior authorization decisions and publicly report certain prior authorization metrics.
Managed Care Plans to Face Sanctions from DHCS for Poor Performance
What’s happening: Medi-Cal managed care plans (MCPs) will face sanctions from the Department of Health Care Services (DHCS) for failing to meet quality performance standards.
What else to know: DHCS has issued All Plan Letter (APL) 23-012, which updates and clarifies the policy on the imposition of administrative and monetary sanctions to plans that fail to meet minimum performance for required quality performance measures.
Department of Health Care Services Issues Updated Enhanced Care Management Guidance
What’s happening: The Department of Health Care Services (DHCS) has issued All Plan Letter (APL) 23-032, which provides updated guidance to Medi-Cal managed care plans (MCPs) on the provision of enhanced care management (ECM).
What else to know: ECM is a component of the California Advancing and Innovating Medi-Cal initiative.
New Managed Care Plan Changes in January Help Advance Health Equity, Access, and Accountability
What’s happening: Effective Jan. 1, 2024, Medi-Cal managed care plans (MCPs) will operate under a new and revamped contract intended to better advance quality, access, accountability, health equity, and transparency.
What else to know: Also effective Jan. 1, 2024, MCPs available for enrollment in certain counties will change due to county-elected model changes, the awarding of new commercial MCP contracts, and/or the expansion of direct contracts with Kaiser Permanente.
Full-Scope Medi-Cal Coverage Expanded to Eligible Adults Regardless of Immigration Status
What’s happening: Effective Jan. 1, 2024, California will provide full-scope Medi-Cal benefits to individuals ages 26 to 49, regardless of citizenship or immigration status, who otherwise meet financial eligibility criteria for the program.
What else to know: The state previously expanded full-scope eligibility for similarly situated people ages 19 to 25 in 2020 and people 50 and older in 2022.
DHCS Receives Federal Approval of the 2023-24 Hospital Fee Program
What’s happening: On Dec. 15, the Department of Health Care Services (DHCS) received federal approval of the 2023-24 Hospital Fee Program, originally submitted in March 2023.
What else to know: The program runs from Jan. 1, 2023, to Dec. 31, 2024, and will provide California’s hospitals with an annual net benefit of approximately $5.3 billion per year on an accrual basis over the 24-month period.