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 federal governments.
The California Health Care Foundation and UC Berkeley’s Institute of Governmental Studies have conducted a statewide survey to assess Californians’ attitude about the Affordable Care Act (ACA), Medi-Cal, and health insurance coverage of treatment for mental health and substance use disorders. The data are broken down by region, age, race, gender and income. Overall findings include:
More than half (56 percent) of Californians worry that they or a family member will lose coverage if the ACA is repealed and replaced.
Support for the ACA is at a record-high 65 percent.
Medi-Cal is recognized as an important program by 88 percent of Californians, spanning the state’s regions and political parties.
Three in four Californians believe that coverage for mental health and substance use disorder services is very important, and that this treatment can help people lead healthy and productive lives.
The Kaiser Family Foundation has released the attached issue brief analyzing which states are most at risk from the American Health Care Act (AHCA) proposal to end enhanced federal matching funds for Medicaid expansion, established as part of the Affordable Care Act (ACA). The proposal would cap – and significantly reduce – the amount of federal funding states receive for Medicaid through a per capita cap or block grant. According to the Congressional Budget Office, the AHCA as passed by the House would reduce federal Medicaid spending by $834 billion from 2017-26, and reduce enrollment by 14 million by 2026; the Trump Administration’s proposed budget would further reduce Medicaid spending. While all states would face challenges related to these cuts, states with limited Medicaid programs, poor health status, high cost markets or low state fiscal capacity would have the most difficulty responding to per capita cap or block grant policies. The brief finds that in states that expanded Medicaid coverage post-ACA, such as California, a scaling back or elimination of expansion coverage is likely.
The next Medi-Cal Children’s Health Advisory Panel meeting will be held on June 28 from 10 a.m.-2 p.m. in Sacramento. The panel, which advises the Department of Health Care Services (DHCS) on policy and operational issues that affect children in Medi-Cal, is comprised of recognized stakeholders/experts in their fields, practicing or certified medical professionals, advocates who represent the interest of children’s health, and parent members. Those unable to attend in person may join via conference call by dialing (888) 972-9334 and entering passcode 2642685. The meeting agenda and additional materials will be posted on the DHCS website when available. Questions should be directed to MCHAP@dhcs.ca.gov.
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) approved 15 applications for Whole Person Care (WPC) pilot projects, authorizing seven new pilots and expanding eight that were previously approved. The WPC pilot program — developed under California’s section 1115(a) demonstration waiver, titled “California’s Medi-Cal 2020 Demonstration” — is intended to provide locally based comprehensive care to particularly vulnerable Medi-Cal members. The pilots aim to coordinate physical health, behavioral health and social services in a patient-centered manner, improving the health and well-being of Medi-Cal members who are high users of multiple health systems and continue to have poor health outcomes. For a list of CMS’ approved WPC pilot projects for the first and second rounds, and for more information about the program, please visit the Department of Health Care Services website.
Payments for Medi-Cal and other services funded through state programs, originally scheduled for June 22, will be deferred to July 7 after the 2017-18 state budget is enacted on July 1. Payments to the Every Woman Counts program will be excluded from the June checkwrite hold, but the hold applies to:
California Children’s Services (state only)
Genetically Handicapped Persons Program
Family Planning, Access, Care and Treatment (PACT) Program
The California Department of Health Care Services (DHCS) will conduct a webinar June 14 from 3–4 p.m. (PT) to present an updated edition of its Medi-Cal Managed Care Performance Dashboard. According to DHCS, the performance dashboard is used to monitor Medi-Cal managed care plans and gain a better understanding of individual managed care plans, as well as assess the plans on a statewide aggregate level. The performance dashboard reports on enrollment, appeals and grievances, network adequacy, financial standing and quality. In addition to performance measures, the data include subsets of the Medi-Cal population and provide basic facts about the program, such as number of enrollees in each plan and demographics by county and plan (language, age, aid categories, etc.). Registration is available online. Previous editions of the performance dashboard are available on the DHCS website. Subsequent editions will be published quarterly.
The California Budget & Policy Center has released a new fact sheet that offers updated and in-depth data on Medi-Cal coverage in every California county. Using California Department of Health Care Services data, the analysis provides Medi-Cal enrollment by age, enrollment as a share of the total statewide population and each county’s ranking by Medi-Cal enrollment. Medi-Cal provides health care services to more than 13 million low-income Californians who live in all 58 counties. Of the 10 counties with the highest share of residents enrolled in Medi-Cal, six are in the San Joaquin Valley: Tulare (54.8 percent), Merced (50.9 percent), Fresno (49.9 percent), Kern (45.9 percent), Stanislaus (45.1 percent) and Madera (45.1 percent).
The California Department of Health Care Services (DHCS) has released the attached All Plan Letter providing guidance to Medi-Cal managed care health plans on non-emergency medical transportation (NEMT) and non-medical transportation (NMT) services, pursuant to AB 2394 (Chapter 615, Statutes of 2016). AB 2394 provides that, effective July 1, 2017, NMT for a Medi-Cal managed care plan member seeking Medi-Cal medical, dental, mental health or substance use disorder services is covered, subject to utilization controls and permissible time and distance standards. The APL outlines the requirements for NEMT, NEMT physician certification forms, NMT, conditions for NMT services, NMT private vehicle authorization requirements, NMT authorization, and the NMT and NEMT access standards. The full All Plan Letter is attached. All DHCS All Plan Letters are available on the DHCS website.
The Kaiser Family Foundation has released an issue brief highlighting 10 facts about Medicaid, the public health insurance program that covers one in five Americans – including many with complex and costly needs for medical care and long-term services. The program is designed to support low-income children, adults, seniors and people with disabilities, many of whom would be underinsured or uninsured without it. The report examines Medicaid’s cost-effectiveness in providing health care coverage at a lower per-person cost than private insurance could. The report acknowledges that Medicaid keeps coverage and care affordable for low-income Americans – and in effect bolsters the private insurance market by acting as a high-risk pool. The report notes that more data on Medicaid’s impact on health outcomes are becoming available, and initial results indicate that not only does Medicaid improve access to care for both children and adults with low income, but it also may be associated with significant reductions in mortality.
The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for program year 2016 attestations for the Medi-Cal Electronic Health Record Incentive Program to May 23. Because CMS’ website is non-operational as of April 28, expected to continue through May 2, the California Department of Health Care Services (DHCS) requested an extension for all providers. According to DHCS, hundreds of providers in California have yet to attest for 2016. Providers wishing to attest for program year 2017 must wait until 2016 attestations close; 2017 attestation may not be available until May 24. Questions should be directed to firstname.lastname@example.org or (916) 552-9181.
CHA participated on a panel addressing the barriers that prevent access to care for Medi-Cal beneficiaries during yesterday’s Senate Budget Subcommittee on Health hearing. Other panelists included representatives from the California Medical Association, California Primary Care Association, California Dental Association and UC Health. Amber Kemp, CHA vice president, health care coverage, testified on CHA’s behalf and discussed the following:
The Medi-Cal expansion and reduced payments to primary care physicians enacted during the economic downturn are driving increased demand for hospital services
Medi-Cal members often seek preventive and other non-urgent care in hospital emergency rooms when they do not have access to primary care providers or specialists
Many Medi-Cal patients still lack appropriate access to mental health and substance use disorder treatment services, although the Affordable Care Act expanded coverage for these services
Many hospitals face significant difficulty securing needed post-acute care for Medi-Cal patients
The Department of Health Care Services has released a statistical brief analyzing the optional Medi-Cal expansion under the Affordable Care Act (ACA), which began in October 2016. The ACA extended Medicaid eligibility to non-elderly adults with incomes under 138 percent of the federal poverty level. In October 2016, nearly 4 million Californians aged 19 to 64 — 9.5 percent of the statewide population, or one in 11 Californians — were enrolled in Medi-Cal as a result of the ACA. The brief describes the Medi-Cal eligibility pathway for newly eligible individuals; historic growth of Medi-Cal’s optional adult ACA expansion population; demographic composition of the population; and the percent of each county and congressional district’s population that is eligible under the optional expansion.
The Department of Health Care Services (DHCS) has changed an eligibility rule for hospitals applying to the program year 2016 Medi-Cal Electronic Health Record Incentive Program for the first time. Previously, DHCS required hospitals to submit cost report data for a continuous 12-month period ending before the start of the federal fiscal year (Oct. 1-Sept. 30) that serves as the program year for the Medi-Cal EHR Incentive Program. Under the recent change, hospitals will be able to submit data for the 12-month period before the fiscal year ends. In addition, hospitals with a new CCN must reapply to the program.
Hospitals are reminded that program year 2016 marks the last opportunity to start the program; applications from hospitals that have not successfully participated in the 2016 program will not be accepted for 2017 and subsequent years. Applications are due May 2. For more information, visit http://medi-cal.ehr.ca.gov/ or call (916) 552-9181.
The Centers for Medicare & Medicaid Services (CMS) has issued the attached final rule that addresses how third-party payments are treated in calculating the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments. Specifically, the rule defines uncompensated care costs as net of third-party payments, including payments by Medicare and private insurance. In California, the federal Medicaid DSH allotment is almost entirely allocated to the public hospitals, as private hospitals receive Medi-Cal DSH replacement payments.
In comments submitted last year, CHA urged CMS to withdraw the proposed rule and instead await the outcome of several pending court cases on the same issue. A federal court recently barred CMS from using subregulatory guidance to calculate Medicaid DSH payments, in a New Hampshire case where enforcement of the proposed calculation as implemented via subregulatory guidance was challenged. However, CMS is expected to appeal the decision and argue that the issuance of this final rule appropriately notifies hospitals of the policy change. CHA is analyzing the final rule and will provide members with more information in the coming weeks.
The Medi-Cal Inmate County program will begin April 1 for participating counties, including Alameda, Fresno, Kern, Los Angeles, Sacramento, Santa Clara and Stanislaus. Calaveras, Placer and San Luis Obispo counties are scheduled to begin July 1. Providers that treat inmates under the custody of counties that have opted into the Medi-Cal Inmate County program should bill Medi-Cal directly for services provided on or after their agreement date. Applicable services include inpatient services at a medical facility located off the grounds of the correctional facility for an extended stay of more than 24 hours. For more information and a full list of participating counties, visit the Medi-Cal website. Questions should be directed to DHCSIMCU@dhcs.ca.gov.
Seema Verma was confirmed this week as the Administrator for the Centers for Medicare & Medicaid Services. Verma was previously an Indiana-based consultant and worked with Vice President Mike Pence to reform Indiana’s Medicaid program. Verma was confirmed by the U.S. Senate by a vote of 55 to 43.
The California Department of Health Care Services (DHCS) has extended the deadline for 2016 attestations for the Electronic Health Record (EHR) Incentive program to May 2. Meaningful use (MU) attestations for program year 2016 will be accepted until that date; the State Level Registry will then switch to accepting 2017 MU attestations only, which initially will only be available for Stage 2. Providers will not be able to attest to Stage 3 until Oct. 24. Those that have previously attested to MU will be required to use a full year reporting period for clinical quality measures (CQMs), while providers that have not previously attested to MU will be able to use 90-day reporting periods for both CQMs and objectives. DHCS has requested that the reporting periods for objectives and CQMs be 90 days for all providers, but has not yet received approval from the Centers for Medicare & Medicaid Services. Providers that are ineligible for the Medicaid EHR Incentive program may submit an alternate MU attestation to avoid Medicare payment adjustments; that deadline has been extended to March 13. More information is available at http://medi-cal.ehr.ca.gov/.
The Centers for Medicare & Medicaid Services (CMS) has issued the attached final rule limiting states’ ability to increase or create new pass-through payments for hospitals, physicians or nursing homes under Medicaid managed care contracts.