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.

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.

House Passes First Package to Fund Federal Government, Includes Health Provisions

What’s happening: The U.S. House passed the Consolidated Appropriations Act of 2024, which will fund a portion of the federal government through the end of the fiscal year. The package includes a group of CHA-supported health care provisions important to hospitals.  

What else to know: Congress has until March 22 to pass a second package to fund the rest of the federal government, including the Department of Health and Human Services.  

DHCS Releases Distinct-Part Nursing and Subacute Rates

What’s happening: Last week, the California Department of Health Care Services (DHCS) posted updated payment rates for distinct-part nursing facilities (DP-NF) and distinct-part subacute facilities (DP-SA) for adults and pediatrics.   

What else to know: Now that DP-NF and DP-SA services have been fully carved into Medi-Cal managed care plans’ (MCPs) scope of benefits, DHCS has implemented a policy that transitions the DP-NF and DP-SA rate year to a calendar year to align with the Medi-Cal managed care rate year.   

DHCS Issues Private Hospital Supplemental Funds Round B Payments

What’s happening: Over the past two weeks, the Department of Health Care Services (DHCS) issued Private Hospital Supplemental Fund Round B payments to hospitals eligible for the program in fiscal year 2023-24.   

What else to know: This round of payments to the approximately 90 eligible hospitals totaled roughly $60 million.   

CHA Encourages Members to Participate in the Vitality Index Payer Scorecard

What’s happening: CHA is endorsing member participation in the Vitality Index Payer Scorecard, which will provide critical information to support CHA’s advocacy to hold insurers accountable for timely and accurate reimbursement.  

What else to know: The CHA Board of Trustees has endorsed this tool, which will automatically draw de-identified claims and remittance information from hospitals without requiring additional reporting or surveys.