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.

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.    

DHCS Will Host Dec. 19 Webinar on Medi-Cal Professional Targeted Rate Increases

What’s happening: The Department of Health Care Services (DHCS) is hosting an open webinar on Dec. 19 at 3 p.m. (PT) to answer questions about the implementation of targeted rate increases for Medi-Cal professional services, effective Jan. 1, 2024.    

What else to know: Under the 2023 Budget Act, DHCS received authorization (pending federal approval) to increase rates for certain primary care, obstetric, and non-specialty mental health procedures to 87.5% of Medicare rates.   

DHCS Releases Updated Managed Care Utilization Data to Determine Hospital Directed Payments

What’s happening: On Dec. 8, the Department of Health Care Services (DHCS) released the latest round of Medi-Cal managed care utilization data to hospitals and health plans, which is 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 as uploaded files will be deleted within 45 days.   

DHCS Changes How Hospitals Access Their Payment Data Files

What’s happening: On Dec. 15, the Department of Health Care Services (DHCS) is scheduled to discontinue access to their current secure data portal. Hospitals download data from this portal to use for various Medi-Cal payment programs.   

What else to know: Hospitals that have not done so already are required to sign up for a new, more secure data portal that includes multi-factor authentication.   

Children’s Behavioral Health Services Lack Timely Access

What’s happening: The California State Auditor recently investigated children’s access to Medi-Cal-covered behavioral health services.  

What else to know: The auditor concluded that many Medi-Cal health plans were out of compliance with state requirements for timely care and that the Department of Health Care Services (DHCS) is not adequately disciplining health plans.

DHCS Authorizes Doulas Without Physician Approval for Any Medi-Cal Member

What’s happening: A new update on doula regulations from the Department of Health Care Services (DHCS) removes the need for physician approval to allow doulas to be present during deliveries in hospitals.  

What else to know: DHCS Medical Director, Karen Mark, MD, has authorized doula services for any Medi-Cal member who is pregnant or was pregnant within the past year and wishes to receive services from a doula while pregnant or within one year of pregnancy.  

Area Wage Index Litigation

This page contains important, members-only information related to the Centers for Medicare & Medicaid Services’ recently finalized area wage index policy. To continue, please log in to your member account.