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Medi-Cal / Medicaid

Overview

Medi-Cal/Medicaid

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.

CHA News Article

Partnering With Stakeholders Vital to Successful Enrollment Strategies
Series conclusion focuses on building relationships to increase enrollment

Amber Kemp

CHA has launched a weekly series of strategies to help hospitals enroll patients in coverage through the Covered California marketplace and the Medi-Cal program. This week’s two-part installment concludes the series by addressing partnerships with key stakeholders and service vendors.

Strategy 6 emphasizes community partnerships hospitals should build for enrollment outreach, including those with health care organizations, physicians and other providers, state and county agencies, and community sites such as schools and places of worship. The strategy also shares information on developing a partnership with Covered California, including a toolkit of ready-to-use information that can be shared with patients and local communities.

CHA News Article

Updated Reimbursement Rates Posted for Skilled-Nursing, Subacute Care Units

Patricia Blaisdell, FACHE Ronald Yaw

The Department of Health Care Services has posted reimbursement rates for distinct-part skilled-nursing facilities and subacute care units  for the 2017-18 rate year. The department projects that the rates, which are effective for services provided beginning Aug. 1, 2017, will be implemented in late December.  

CHA News Article

Report Examines How Fear and Toxic Stress Affect Health of Immigrant Families

Amber Kemp

A new report from the Kaiser Family Foundation analyzes how uncertainty over immigration policy can lead to fear and toxic stress that impact well-being and health. To gather data, researchers conducted focus groups with 100 parents from 15 countries and 13 interviews with pediatricians to gain insight into how the current environment is affecting the daily lives, well-being, and health of immigrant families, including their children. Key findings include:

  • Immigrant families, including those with lawful status, are experiencing resounding levels of fear and uncertainty.
  • Parents and pediatricians said that racism and discrimination, including bullying of children, have significantly increased since the election.
  • Daily life has become more difficult for immigrant families due to increased fear and uncertainty.
  • Most parents said they are continuing to access health care for their children and maintaining their children’s Medicaid and CHIP coverage, but there were some reports of changes in health care use and decreased participation in programs.
  • Increased fears are having significant negative effects on the health and well-being of children that have lifelong consequences.
CHA News Article

Update Issued on Drug Medi-Cal Organized Delivery System Waiver

Amber Kemp

The California Department of Health Care Services has provided an update on the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver, a voluntary pilot program that offers California counties the opportunity to expand access to care for Medi-Cal enrollees with substance use disorders. The program’s goal is to demonstrate that organized care for substance use disorders improves beneficiary health outcomes while decreasing system-wide health care costs. Counties that choose to participate in the DMC-ODS are required to provide access to a full continuum of benefits modeled after the American Society of Addiction Medicine criteria, in addition to other requirements.

The department notes that 40 counties from the first four implementation phases submitted implementation plans prior to the Sept. 1 deadline; of those, 26 have been approved.

CHA News Article

Innovative Strategies Vital to Enrolling Vulnerable Populations in Health Coverage

Amber Kemp

CHA has launched a weekly series of strategies to help hospitals enroll patients in coverage through the Covered California marketplace and the Medi-Cal program. This week, the strategy focuses on helping vulnerable populations – including individuals who are homeless, have a mental illness or substance use disorder, or are undocumented – enroll in health coverage. Without such coverage, these hard-to-reach populations may use hospital emergency rooms as their primary care site or forgo treatment altogether.

Hospitals are encouraged to develop innovative strategies to reach these individuals. Ideas include using eligibility and enrollment services vendors to visit shelters and other places where homeless individuals gather, or giving individuals who are homeless taxi vouchers and bus tokens to get to public places where they can obtain the information required for an application.

CHA News Article

CHA Joins Litigation Effort to Overturn Cuts to 340B Program

Jackie Garman Alyssa Keefe

CHA has joined 31 other state and regional hospital associations in filing the attached amicus (friend of the court) brief in a lawsuit challenging the Centers for Medicare & Medicaid Services’ proposed cuts to the Medicare 340B Drug Pricing Program. 

In American Hospital Association v. Hargan, filed on Nov. 13, the American Hospital Association and various other hospital associations, hospitals and health systems seek to invalidate the finalized regulation that would cut payments to many hospitals in the 340B program by nearly 30 percent. According to the amicus brief filed by CHA and the other hospital associations last Friday, “If the new rule is allowed to stand, safety-net providers will be forced to eliminate or dramatically curtail crucial programs that treat a wide range of medical conditions – from cancer to mental health disorders to diabetes to opioid addiction to HIV/AIDS … Given their unique position, amici respectfully submit this brief to inform the Court about what will happen if CMS is permitted to take a scalpel — or really, an old-fashioned amputation saw — to the 340B Program.”

Plaintiffs seek a preliminary injunction to prevent the regulation from going into effect on Jan. 1, as scheduled; the defendant has responded with a motion to dismiss the lawsuit. Both motions are scheduled to be heard by the court on Dec. 21.  

CHA News Article

Positioning Trained Staff at Key Access Points Helps During Open Enrollment
Fourth strategy in weekly series highlights placement, training of enrollment staff

Amber Kemp

CHA has launched a weekly series of strategies to help hospitals enroll patients in coverage through the Covered California marketplace and the Medi-Cal program. This week, the strategy helps hospitals position trained staff at critical access points, which typically include inpatient admitting areas, emergency departments, obstetrics departments, pharmacies, laboratories, urgent care facilities, women’s clinics, ambulatory surgical facilities and other outpatient sites. Positioning enrollment staff in these access points is an effective way for hospitals to build strong relationships with patients. Staff responsibilities and training vary by hospital and access points within the facility; training designed for specific roles and needs is essential to effective enrollment functions.

Covered California announced today that more than 102,000 new consumers have signed up for coverage between Nov. 1 and Nov. 30, representing a 28 percent increase in enrollment over the same time period in 2016, when approximately 80,000 consumers signed up for coverage. 

CHA News Article

New Resources Explain Investor Opportunities in Medicaid Market

Amber Kemp

The California Healthcare Foundation has created a series of resources to help investors and entrepreneurs better understand the Medicaid market. The foundation asserts that demand for emerging technologies that increase access and improve value in the Medicaid market is high, that entrepreneurs are best suited to provide needed innovations, and that safety-net providers best understand the demands of the market. The resources are intended to help bridge the gap between providers and market innovators. More information and links to the new resources are available at www.chcf.org/projects/2017/opportunities-emerging-technologies-medicaid.

CHA News Article

Partnership Approach Helps Hospitals Educate Patients During Open Enrollment
Third strategy in weekly series highlights Covered California outreach for 2018

Amber Kemp

CHA has launched a weekly series of strategies to help hospitals enroll patients in coverage through the Covered California marketplace and the Medi-Cal program. This week’s strategy is intended to help hospitals determine how to approach and communicate with patients to best educate them about the eligibility and enrollment process. The strategy explains that developing a partnership-like relationship with patients creates trust and engages them in a conversation about their health coverage options.

For the current open enrollment period, Covered California is undertaking an extensive marketing, education and outreach campaign to inform patients about their coverage options and has budgeted $111 million for the upcoming 2018 coverage year. In addition, shopping and enrolling in coverage are easier than ever this year due to upgrades to the online experience:

  • For the first time, Covered California’s website is mobile friendly, enabling consumers to shop, find local help, enroll and manage their account on a cell phone or tablet.
  • A new provider directory allows consumers to see which doctors and hospitals are available in which plans.
  • The application for health coverage has been simplified for easier navigation.
  • Upgrades to the website make it easier for consumers to find resources and in-language phone support in 12 languages on the home page and under a new “Contact Us” page.

The complete strategy series, as it is published, will also be available at CHA’s dedicated web page.

CHA News Article For Members

CHA Provides Overview of Federal Legislation Critical to Hospitals

As the calendar year winds down, Congress is grappling with a wide range of issues, most of which have implications for California’s hospitals and the patients they care for. CHA is actively engaged with the congressional delegation on broad issues such as tax reform, funding for the federal government and spending caps, as well as hospital-focused legislation — including Medicare payments for small and rural hospitals, post-acute care providers and participants in the 340B program. The Children’s Health Insurance Program, telehealth and the Deferred Action for Childhood Arrivals program are also on the congressional docket; the disposition of these issues will impact hospitals’ patients and employees.

To help member hospitals follow these issues, CHA has prepared the attached chart with helpful links to CHA Advocacy Alerts, letters and legislative language. 

CHA News Article

Remittance Advice Details, Medi-Cal Financial Summary Soon Available Online
PDF format will be available on Medi-Cal website

Amber Ott

The Department of Health Care Services has announced that providers will soon be able to securely view and download a PDF version of their paper remittance advice details and Medi-Cal financial summary. To access the documents online at the Medi-Cal website, providers must have a signed Medi-Cal Point of Service (POS) Network/Internet Agreement form on file, a national provider identifier and a PIN.

The benefits to accessing the remittance advice details and Medi-Cal financial summary online include:

  • Earlier availability than paper versions and no charge for the new online service
  • Up to six calendar weeks of remittance advice details will be available for immediate download, eventually building a historical database that will include three years of data available within one business day of request
  • Acceptance of the printed version of the online PDFs as supporting documentation with claims inquiry and appeals forms
CHA News Article

Hospitals Should Determine Optimum Staffing, Support for Open Enrollment
Second strategy in series addresses key components for successful eligibility, enrollment process

Amber Kemp

CHA has launched a weekly series of strategies to help hospitals enroll patients in coverage through the Covered California marketplace and the Medi-Cal program. This week’s strategy is intended to help hospitals determine the staffing levels and qualifications necessary for a successful eligibility and enrollment process. The strategy details three key components identified by interviewed organizations, including staffing characteristics and needs; training, ongoing education and assessment; and specific staff education with a focus on patient educational communications.

Hospitals are leaders in helping Californians enroll — and stay enrolled — in health coverage. Because ongoing debate at the federal level about the Affordable Care Act has left many Californians uncertain about the future of health insurance marketplaces, this year’s open enrollment period is more crucial than ever.

CHA News Article

CHA Tools Aim to Help Hospitals During Open Enrollment
First of seven strategies focuses on eligibility, verification of uninsured

Amber Kemp

As reported in yesterday’s CHA News, CHA has launched a weekly series of strategies to help hospitals enroll patients in coverage through the Covered California marketplace and the Medi-Cal program. This week’s strategy provides a wide range of information and ideas on eligibility screening, verification and enrollment of the uninsured. It includes details on how other hospitals have addressed the key components of a successful process: transparency, consistency and effective tools.

Hospitals are leaders in helping Californians enroll — and stay enrolled — in health coverage. Because ongoing debate at the federal level about the Affordable Care Act has left many Californians uncertain about the future of health insurance marketplaces, this year’s open enrollment period is more crucial than ever.

Covered California today issued its first enrollment snapshot for the first two weeks of the current open enrollment period. From Nov. 1 through Nov. 14, more than 48,000 new consumers signed up for coverage through Covered California, which is slightly ahead of last year’s pace when more than 39,000 consumers selected a plan during the first two weeks of November 2016. 

Each week, CHA News will include a new strategy for hospitals to explore. The complete strategy series, as it is published, will also be available at CHA’s dedicated web page.

CHA News Article

Bipartisan Bill Would Prevent Cuts to 340B Program

Anne O'Rourke

Reps. David B. McKinley (R-WV) and Mike Thompson (D-CA) have introduced House Resolution 4392, a bipartisan bill that would block cuts for hospitals that participate in the 340B Drug Pricing Program.

The bill would reverse the Centers for Medicare & Medicaid Services’ finalized proposal to cut payments by 28 percent — $1.6 billion — to certain hospitals for drugs purchased under the 340B program. In September, a majority of House members signed on to a letter opposing the cuts. In the California delegation, 28 members cosigned the letter.

Hospitals that benefit from the 340B program should ask their member of Congress to cosponsor the bill. To find contact information for your representative, visit www.house.gov/representatives/find.

CHA News Article

Ballot Initiative Aims to Improve Community Health Through Additional Funding

Anne McLeod

The California Care Act ballot initiative was filed with the Attorney General’s office today. The Act would impose a 1 percent tax on the portion of taxable income over $1 million. The proceeds would be deposited into special funds in the state treasury — separate from the General Fund — and would be used to make payments to not-for-profit and health care district safety net hospitals and community health clinics, and to increase the availability of frontline health care workers in California. Payments to hospitals would be distributed according to the proportion of adjusted Medi-Cal patient days that an individual hospital provides. 

Through these distributions, the Act intends to improve the health and well-being of communities and community members, and to generally support hospitals’ ability to offer quality, accessible care. The distributions would not be considered as reimbursement by any payer for services rendered, and the funding will not offset any other funding provided by any government entity. Proponents of the measure include officials from Service Employees International Union-United Healthcare Workers West.

CHA News Article

New Law Requires Hospitals to Retain Medi-Cal Records for 10 Years

Lois Richardson Amber Kemp

A new state law, effective Jan. 1, 2018, requires hospitals and other providers of health care services rendered under Medi-Cal or any other California Department of Health Care Services health care program to keep records for at least 10 years. Specifically, Assembly Bill 1688 (Chapter 511, Statutes of 2017) requires providers to keep a record of each service rendered, the beneficiary or person to whom rendered, the date of service and any additional information that the Department of Health Care Services may require. These records must be maintained for 10 years from the final date of the contract period between the plan and the provider (for Medi-Cal managed care enrollees), from the completion date of any audit or from the date the service was rendered, whichever is later.

The new law effectively changes the length of time a provider must keep medical records of Medi-Cal patients. Currently, state law requires medical records of adults or emancipated minors to be retained for seven years; and for unemancipated minors, until the minor reaches age 19, but no fewer than seven years.

CHA News Article

August 2017 Medicaid Enrollment Data Available
Also includes Children's Health Insurance Program

Amber Kemp

The Centers for Medicare & Medicaid Services has released national data on Medicaid and Children’s Health Insurance Program enrollment and eligibility activity by states for August 2017. According to the report, enrollment has increased by 16.4 million individuals, representing a 29 percent increase, since the baseline period prior to the start of the first marketplace open enrollment period (July – Sept. 2013). A total of 74,305,276 individuals were enrolled in all 50 states and the District of Columbia as of August 2017. The report is available online, along with previous monthly reports dating back to 2013.

CHA News Article

All Plan Letter Explains Managed Care Plans’ Obligations for Alcohol Misuse Interventions

Amber Kemp Sheree Lowe

The Department of Health Care Services (DHCS) has issued the attached All Plan Letter outlining Medi-Cal managed care health plans’ obligation to provide alcohol screening and intervention services. Existing policy requires plans to ensure that primary care providers screen members as part of routine care, including administering an individual health education behavioral assessment. According to DHCS, plans must cover and pay for expanded alcohol screening for members 18 years of age and older who answer “yes” to questions in the assessment that identify potential alcohol misuse. Plans are also required to cover and pay for behavioral counseling interventions for members who screen positively for risky or hazardous alcohol use or a potential alcohol use disorder.

CHA News Article

Senate Budget Subcommittee to Examine Medi-Cal Network Adequacy Nov. 9

Amber Kemp Barbara Glaser

The Senate Budget Subcommittee on Health and Human Services will hold an oversight hearing on Nov. 9 at 10 a.m. addressing adequate provider networks in Medi-Cal managed care. Titled “Achieving and Maintaining Adequate Provider Networks in Medi-Cal Managed Care,” the hearing will include a presentation from Department of Health Care Services on Medi-Cal managed care rate-setting and implementation of new state and federal requirements; a panel on Medi-Cal managed care organizations featuring representatives from several health plans; and a panel with responses from Medi-Cal providers and consumers. Jeff Conklin, vice president, payer and network strategies, Adventist Health, will represent CHA on the panel.

The hearing is also scheduled to include a public comment session. The agenda and speaker biographies are attached, and the committee will post a background document to its website later this week. In April, CHA participated on a panel before the subcommittee addressing several barriers that prevent access to care for Medi-Cal beneficiaries.

CHA News Article

House Passes Bill to Fund CHIP, Delay Medicaid DSH Cuts

Anne O'Rourke

The U.S. House of Representatives today passed H.R. 3922, the Championing Healthy Kids Act of 2017, which would extend funding for the Children’s Health Insurance Program (CHIP) for five years. The bill also delays reductions to Medicaid disproportionate share hospital (DSH) payments currently scheduled for federal fiscal years 2018 and 2019. To compensate for the delay, the bill increases DSH cuts scheduled for 2020-24. The bill, which passed the House by a vote of 242-174, will move to the Senate where 60 votes are needed to pass it. Earlier this week, CHA sent a letter supporting the CHIP and Medicaid DSH provisions in this legislation to all members of the California delegation.

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