Medi-Cal is California's Medicaid program — a public health insurance program that provides needed health care services for low-income families with children, seniors, people with disabilities, foster caregivers, pregnant women and low-income people with specific diseases, such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the state and federal governments.
Medi-Cal is California’s Medicaid program — a public health
insurance program that provides needed health care services for
low-income families with children, seniors, people with
disabilities, foster caregivers, pregnant women and low-income
people with specific diseases, such as tuberculosis, breast
cancer or HIV/AIDS. Medi-Cal is financed equally by the state and
CHA’s upcoming Hospital Finance
and Reimbursement Seminar will address significant, imminent
changes to Medi-Cal and Medicare reimbursement. Over the past
year, federal and state lawmakers and agencies have made changes
that will directly impact how hospitals are reimbursed,
ultimately transforming the way care will be delivered in the
The Supreme Court ruled
this week that the Department of Health and Human Services (HHS)
violated the Medicare Act when, in 2014, it changed the
calculation for payments to disproportionate share hospitals
(DSH). The 7-1 court ruling could affect billions of dollars in
Medicare payments to safety net hospitals.
The Centers for Medicare & Medicaid Services (CMS) has issued a
rule revising and updating requirements for
Programs for All-Inclusive Care for the Elderly (PACE). PACE
provides comprehensive medical and social services to individuals
who qualify for nursing home care but can still live safely in
A total of 302 members of Congress signed on to a
bipartisan House letter urging Congress to delay cuts to
Medicaid disproportionate share hospitals for at least two
years. An overwhelming majority — 48 of 53 — of members
of the California delegation cosigned the letter. CHA
strongly supports this bipartisan effort and thanks members for
their engagement on this critical issue.
As of April 1, 26 counties were approved to deliver Drug Medi-Cal
Organized Delivery System (DMC-ODS) services, representing nearly
88 percent of the Medi-Cal population statewide. Fourteen
additional counties are in various phases of implementation.
Yesterday, CHA issued a
news release on Gov. Newsom’s revised 2019-20 state budget.
CHA applauds the Governor for making investments that improve
Californians’ health and well-being, including: ongoing support
for expanding Medi-Cal coverage to young adults, regardless of
immigration status; imposing a state-level individual coverage
mandate; broader premium subsidies for low and middle-income
families; and significant investments in behavioral health.
On Feb. 28, the Centers for Medicare & Medicaid Services (CMS)
approved the Home- and Community-Based Services Assisted Living
Waiver (ALW) renewal, effective March 1, 2019, through Feb. 28,
2024. The renewal includes 2,000 slots added in the CMS-approved
amendment from October 2018, for a total capacity of 5,744.
The Department of Health Care Services (DHCS) last week received
federal approval of a three-year extension of its Cal MediConnect
(CMC) program, which provides coordinated services to patients
who are dually eligible for Medicare and Medicaid.
The Department of Health Care Services earlier this week
announced how it will distribute the Governor’s $100 million
budget allocation to support active Whole Person Care pilot
programs that provide housing services, as well as its
methodology for determining the distributed amounts.
Today, CHA member hospitals participated in a lobby action day in Sacramento to encourage legislators to ask the administration to reset the calculation of Proposition 55 funds. During the event, 20 hospital leaders met with key legislators and their staff, urging them to support the voters’ intent and direct crucial health care funding to Medi-Cal.
Both the Medicare Payment Advisory Commission (MedPAC) and the
Medicaid and CHIP Payment and Access Commission (MACPAC) have
issued their March 2019 reports to Congress, based on
recommendations approved at their January meetings. The
MedPAC report evaluates Medicare payment issues, while the
MACPAC report recommends — among other items — that if
planned Medicaid disproportionate share hospital (DSH) cuts
proceed, they should be phased-in to give states and hospitals
more time to respond.
Earlier this week, CHA attended a Senate Health Committee
informational hearing that examined strategies across all
purchasers and programs that have the objective of improving the
care delivered to people with chronic conditions.
informational series from the California Health Care
Foundation explains various facets of the Medi-Cal program,
including a program overview, challenges of program
eligibility and enrollment, the process and challenges of
payments to Medi-Cal managed care plans, the 2019 edition of
Medi-Cal facts and figures, the intersection of Medi-Cal and
behavioral health, and the Medi-Cal budget process.
Twenty-four counties have now been approved to deliver services
through the Drug Medi-Cal Organized Delivery System Waiver,
according to a recent update from the Department of Health Care
Services (DHCS), with 16 additional counties in various phases of
The Department of Health Care Services (DHCS) has released
All Plan Letter 19-002, which details reporting requirements
for Medi-Cal managed care health plans (MCPs) during the annual
network certification process.
Yesterday, the Department of Health Care Services (DHCS) shared
four approval letters. dated Dec. 12, from the Centers for
Medicare & Medicaid Services (CMS). Hospitals should share
the relevant letters, linked here, with their accounting firms:
CHA has submitted a joint
comment letter responding to the Department of Health Care
Services’ (DHCS) draft All Plan Letter and Provider Bulletin that
address duplicate discounts within the 340B Drug Pricing Program.
study by researchers at University of California,
Berkeley and University of California, Los Angeles projects
up to 4.4 million Californians could be uninsured in 2023 because
of the federal law removing the Affordable care Act’s (ACA)
individual mandate penalty beginning in 2019.
According to a recent update from the Department of Health Care
Services, 19 counties — representing nearly 75 percent of the
Medi-Cal population — are currently approved to deliver Drug
Medi-Cal Organized Delivery System (DMC-ODS) services. The
DMC-ODS waiver is a voluntary pilot program that offers
California counties the opportunity to expand access to care for
Medi-Cal enrollees with substance use disorders.