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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

CMS Issues Bulletin on Enforcement of Medicaid Home Health Final Regulation

Patricia Blaisdell, FACHE Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) has released the attached informational bulletin describing its plans for enforcement of the Medicaid Home Health final rule. The rule expands coverage for medical supplies, equipment and appliances under the Medicaid (Medi-Cal) home health benefit. The rule was effective on July 1, 2016, but CMS delayed the compliance date for up to two years — based on state legislative cycles — recognizing that states are experiencing operational and budgetary issues as they implement the rule.

The bulletin states CMS’ intent to work with states on a case-by-case basis to provide flexibility for certain provisions of the rule. It also clarifies which provisions of the rule are not subject to enforcement flexibility. CMS asks states to contact it by May 31, 2018, to request flexibility.

CHA News Article

CMS Proposes Regulation to Alleviate State Burden
Rule would relax access to care monitoring requirements

Alyssa Keefe Amber Kemp

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would provide states with greater flexibility in how they meet access to care requirements within the Medicaid program.

The proposed rule addresses concerns associated with the 2015 final rule — which CHA commented on — that requires states proposing to reduce or restructure Medicaid fee-for-service payment rates to collect data through an Access Monitoring Review Plan and solicit input on the potential impact on beneficiaries’ access to care. 

CMS proposes to exempt states with an overall Medicaid managed care penetration rate of 85 percent or greater from most fee-for-service access monitoring requirements; California’s current Medi-Cal managed care penetration rate is 80 percent.

CHA News Article

CHA Provides Hospital Data by Counties and State, Federal Legislative Districts

Ronald Yaw

CHA has developed interactive maps displaying hospital data from across the state. Featuring 2016 annual data from the Office of Statewide Health Planning and Development, the maps allow users to find information for specific geographic areas, including Senate districts, Assembly districts, congressional districts and counties. The maps include data on:

  • Emergency department visits
  • Hospital births
  • Medicare and Medi-Cal patient days
  • Licensed beds
  • Hospital employees
CHA News Article

Regulations Proposed for Children’s Emergency Medical Services
Comment period ends April 30

BJ Bartleson, RN, MS, NEA-BC

The Emergency Medical Services Authority (EMSA) has issued a proposed rule that would establish guidelines for local Emergency Medical Services Systems for Children (EMSC) programs. Currently, 21 of 33 local emergency medical services agencies have adopted such programs, which are intended to ensure that children receive appropriate emergency medical services. The proposed rule would clarify the requirements for local emergency medical services agencies to develop and implement EMSC programs into their plans.

In addition, the rule would create quality improvement assurance models and outline specific requirements for pediatric facility designation. The proposal also outlines the necessary resources pre-hospital providers and hospital emergency departments should obtain to adequately provide medical services to pediatric patients, from neonates to adolescents. EMSA states that the goals of this rule are to “provide standards for establishing statewide consistency in policy and program elements, support coordination of limited resource of pediatric specialty centers, and improve pediatric patient care within the California EMSC programs.” More information is available in the attached Notice of Proposed Rulemaking.

CHA’s Emergency Medical Services/Trauma Committee is reviewing the proposed rule and asks members to submit any comments or concerns to BJ Bartleson, RN, MS, NEA-BC, CHA vice president, nursing and clinical services, by April 23. 

CHA News Article

Congress Receives March Report on Medicaid and CHIP

Alyssa Keefe

The Medicaid and CHIP Payment and Access Commission (MACPAC) issued its March 2018 Report to Congress on Medicaid and the Children’s Health Insurance Program. The report focuses on two topics of high interest to Congress – managed care and telehealth — and covers the mandated analysis of Medicaid disproportionate share hospital allotments. 

MACPAC recommends amending and revising three separate legal authorities under the Social Security Act to reduce administrative burdens for states implementing Medicaid managed care programs. It suggests extending the approval and renewal periods for all Section 1915(b) waivers from two to five years; permitting Section 1915(c) waivers for beneficiaries’ freedom of choice and selective contracting; and amending Section 1932(a)(2) to allow states to require beneficiaries to enroll in Medicaid managed care programs under state plan authority.

CHA News Article

Updated California Regional Health Care Cost and Quality Atlas Available

Amber Kemp

The Integrated Healthcare Association has released the second edition of its California Regional Health Care Cost & Quality Atlas, reflecting multi-payer data by geographic region — including commercial insurance, Medicare and Medi-Cal — on more than 30 standardized measures of health care quality, cost, patient cost sharing and utilization. Developed with support from the California Health Care Foundation and the California Health and Human Services Agency, the atlas includes information about care provided in 2013 and 2015, just before and after the Affordable Care Act (ACA) coverage expansions took effect. The updated atlas incorporates new characteristics to allow comparison among market segments, subpopulations and the overall insured population. The new characteristics include large group, small group and individual coverage; self-insured employers; Covered California; risk-sharing arrangements; accountable care organizations; and clinical condition cohorts.

According to the data, clinical quality in 2015 varied across the state’s 19 geographic regions by an average of 25 percentage points, and costs ranged from 22 percent below the statewide average to 29 percent above.

CHA News Article

DHCS to Reverse Disproportionate Share Hospital Reductions

On Feb. 9, the House of Representatives passed a bill delaying the Medicaid disproportionate share hospital (DSH) payment reduction until Oct. 1, 2020. Previously, the Department of Health Care Services (DHCS) had implemented the DSH reductions on Oct. 1, 2017, to comply with current law.

As a result of the delay, DHCS will now reverse the reductions that have taken place since Oct. 1, 2017, and has updated the program payments to add the previous reductions into the next payment, according to hospital group, as follows:

  • Private hospitals will see the increase in their December-January DSH replacement payment, scheduled for March 1.
  • Non-designated public hospitals will see the increase during the February-March 2018 DSH payment, scheduled for April 26.
  • University of California hospitals will see the increase in the round 3 DSH payments, scheduled for April 5 for certified public expenditures, and April 19 for intergovernmental transfers.
  • Global Payment Program hospitals will see the increase in their prior year 3, quarter 3 payments, scheduled for April 15.
CHA News Article

Report Details Legal Considerations for Approaches to Expand Coverage in California

Amber Kemp

A new issue paper from the California Health Care Foundation shows policy avenues the state could take to expand coverage, including establishing a single-payer system, improving affordability of Covered California plans, expanding Medi-Cal to undocumented adults and creating a public coverage option in Covered California. The paper addresses how these approaches intersect with various federal programs and law, as well as legal issues the state and stakeholders would need to consider under each approach. For each approach, the paper outlines respective policy goals, federal authorities invoked and potential pathways to federal approval.

CHA News Article

Update on Drug Medi-Cal Organized Delivery System Waiver

Sheree Lowe

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.

According to the department, all 40 counties from the first four stages of implementation that submitted implementation plans have been approved. Intergovernmental agreements have been approved for San Francisco, Marin, Riverside, San Mateo, Santa Clara, Los Angeles, Contra Costa, Santa Cruz, Napa, and San Luis Obispo counties through the Centers for Medicare & Medicaid Services, and all have begun delivering DMC-ODS services. The department is providing technical assistance via contracted services, regional meetings, county-specific sessions, tribal consultation, and webinars.  More information about the DMC-ODS is available online.

CHA News Article

Medi-Cal Supplemental Payments for Selected Physician Services Approved

Amber Kemp

On Dec. 5, the California Department of Health Care Services (DHCS) received Centers for Medicare & Medicaid Services (CMS) approval of State Plan Amendment (SPA) 17-030, the time-limited supplemental payment program for certain physician services rendered from July 1, 2017, to June 30, 2018. The effective date of the SPA is July 1, 2017. As previously reported, the payments are for new and established patient office/outpatient visits, psychiatric diagnostic evaluations, psychiatric diagnostic evaluation with medical services and psychiatric pharmacological management services. 

The payments are being made through the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56), which increases the excise tax rate on cigarettes and tobacco products. Under Proposition 56, a specified portion of the tobacco tax revenue is allocated to DHCS for the non-federal share of health care expenditures in accordance with the annual state budget process. 

CHA News Article

President Signs Government Funding Bill
Package includes several important provisions for hospitals, health systems

Anne O'Rourke

The House and Senate today passed, and the President signed, another short-term spending bill to fund the federal government through March 23. The measure includes a number of CHA priorities, as well as a two-year budget agreement and increase to the debt limit. In addition to delaying cuts to Medicaid disproportionate share hospitals by two years and extending a number of rural programs, the measure authorizes the Children’s Health Insurance Program for a total of 10 years, as well as a wide variety of programs relating to telehealth, chronic care delivery and Medicare Advantage. CHA is preparing a summary of the legislation and its estimated impact for California’s hospitals and post-acute care providers. A section-by-section summary of the bill was released in CHA News yesterday.

CHA News Article

DHCS Releases 340B Budget Trailer Bill Language

Amber Ott

Last week, the Department of Finance released the Administration’s budget trailer bill proposals, including the Department of Health Care Services (DHCS) proposal to restrict the federal 340B Drug Pricing Program within Medi-Cal. Specifically, the proposal would require the department to seek federal authorization to prohibit a covered entity from dispensing a drug purchased through the 340B program to a Medi-Cal beneficiary or other individual participating in another program that is eligible for federal drug rebates. CHA opposes the state budget proposal, which would cost safety-net hospitals across the state hundreds of millions of dollars each year. CHA will meet with DHCS and members of the Legislature to share its concerns and mitigate the proposal’s impact on hospitals that participate in the 340B program.  

CHA News Article

House Passes Funding Bill
Senate must pass resolution tonight to avoid shutdown

Anne O'Rourke

On Thursday, the House of Representatives passed by a vote of 230-197 a continuing resolution to extend funding for the federal government through Feb. 16. The measure includes a six-year reauthorization of the Children’s Health Insurance Program but does not include CHA’s other priorities, such as delays in cuts to the Medicaid Disproportionate Share Hospital and 340B Drug Pricing programs as well as several Medicare payment programs. Of the six Democrats who voted “Yes” with the Republicans, two were from California: Reps. Carbajal and Costa. None of the 11 Republicans who voted “No” with the Democrats were from California.

The Senate must pass the resolution by midnight (ET) tonight to avoid a government shutdown. It is not clear whether the 60 votes required to pass the measure are lined up. Congressional leaders are struggling to negotiate overall spending caps for the military and domestic discretionary programs, which is creating the month-to-month process. 

In advance of the potential shutdown, the Department of Health and Human Services released its contingency plan for operations.

CHA News Article

California’s Health Homes Program Approved to Begin in July

Amber Kemp

Yesterday, the California Department of Health Care Services announced that the Centers for Medicare & Medicaid Services has approved California’s proposal to amend its Medicaid State Plan and Medi-Cal 2020 waiver to authorize a health homes program beginning in July 2018. The program, which aims to improve care for Medi-Cal members with chronic health conditions, will be implemented by the department through the Medi-Cal managed care delivery system. The Affordable Care Act authorized an option under which states may use home health programs to coordinate the full range of physical health, behavioral health, and community-based long-term services and supports needed by Medicaid members with chronic conditions. Enhanced federal matching funds of 90 percent are available for two years. The program will provide services for comprehensive care management, care coordination, health promotion, comprehensive transitional care, individual and family support, and referral to community-based and social support services; it is expected to be fully implemented across 29 counties in January 2020. More information is available online.

CHA News Article For Members

New Electronic Health Record Auditing Standards Announced for California

The California Department of Health Care Services has shared with CHA new standards it will apply to the Medi-Cal Electronic Health Record Incentive Program both retroactively and moving forward.

CHA News Article

Medi-Cal Facts and Figures 2017 Reference Guide Provides Snapshot of Key Data Points

Amber Kemp

The California Health Care Foundation has released the attached 2017 quick reference guide with updated data that provides a snapshot of some key Medi-Cal data points, including:

  • Pre and post-ACA Medi-Cal enrollment
  • Enrollment by race/ethnicity, age and aid category
  • An overview of Medi-Cal managed care models
  • Managed care and fee-for-service penetration
  • Medi-Cal share of state expenditures for fiscal years 2014-16
  • Medi-Cal expenditures by service category, Medi-Cal spending per enrollee
  • Medi-Cal participating physicians per 100,000 enrollees
  • The percentage of Medi-Cal enrollees with no usual source of care
  • The percentage of Medi-Cal members who delayed or did not obtain medical care 

The quick reference guide is a snapshot of the foundation’s Medi-Cal Facts and Figures report, a set of materials that provides an overview of Medi-Cal, covering program eligibility and enrollment, benefits, service delivery, background on policy issues, budget and forces that affect the program’s costs. The foundation will publish a fully updated Medi-Cal Facts and Figures report in late 2018.

CHA News Article

Details of Federal Spending Package to Be Issued in CHA News
Congress has until midnight tomorrow to finalize

Anne O'Rourke

Although Congress has finished its work on the tax bill, members have one remaining fiscal responsibility to address because the federal government runs out of spending authority at midnight tomorrow, Dec. 22. CHA has been advocating for the spending package to include a five-year reauthorization of the Children’s Health Insurance Program (CHIP), the Medicare policy extensions, and delays in cuts to the Medicaid disproportionate share hospital and 340B programs.

The House and Senate plan to vote today and tomorrow on a short-term extension of spending authority through Jan. 19, 2018, which includes a three-month extension of CHIP and an important waiver of a budget provision that would have triggered deep cuts in Medicare spending due to the deficit increase created by the new tax bill. It does not include CHA’s other priorities. CHA will issue a detailed report of all the final actions via a special edition of CHA News as soon as Congress adjourns.

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.

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