About Finance & Reimbursement
Even before the COVID-19 pandemic, many California hospitals’ financial situations were challenging — nearly 40% operated in the red. Hospitals strive to contain costs while delivering essential care to their communities in the most cost-effective manner. CHA provides direction to hospitals on the diverse issues that affect their financial performance, and advocates for them to ensure that much-needed programs retain their funding. In addition, CHA offers tools such as DataSuite to help hospitals analyze government reimbursement changes, and the potential impact of regulatory and legislative actions on hospitals.
MEDI-CAL REDETERMINATIONS: The Department of Health Care Services has published a new interactive dashboard detailing statewide and county-level demographic data on Medi-Cal application processing, enrollments, redeterminations, and renewal outcomes. Preliminary data on the Medi-Cal redeterminations show that in San Diego County, 16,336 Medi-Cal beneficiaries were disenrolled effective June 30. In Imperial County, 1,482 beneficiaries were […]
TRANSITIONS OF CARE SUB WORKGROUP: The county of San Diego, along with the Legal Aid Society of San Diego and HASD&IC, helped establish a sub workgroup of the Healthy San Diego Dual Eligible/Long Term Services & Supports (LTSS) Workgroup — the Transitions of Care Sub Workgroup. The Sub Workgroup will focus on pressing matters caused by the gaps and challenges in keeping older/disabled adults receiving Medi-Cal connected to quality care and LTSS. The focus is on access to LTSS for older adults and the regional work around the dually eligible beneficiaries, and transitions of care, whether moving from the community or back into the community, and care coordination by the payer, including the providers and caregivers. If you or someone from your organization is interested in joining, please contact Caryn Sumek at email@example.com.
SAN DIEGO COUNTY BUDGET: The county has released its 2023-24 budget, which addresses a number of issues — homelessness, building healthy and safe communities, investing in working families, mental health and substance use disorders, sustainability, and justice reform. There is an opportunity for the community to comment and provide input before the board deliberates and adopts a budget at the end of June. Community meetings are being held this week, and next month, public hearings will take place.
COVID-19 UNINSURED GROUP PROGRAM: The Department of Health Care Services (DHCS) is clarifying that coverage for this group expires on May 31 — the last day of the month in which the COVID-19 public health emergency ends — not May 11. California has taken advantage of the “optional COVID-19 group,” which provides uninsured and underinsured individuals with Medi-Cal coverage for COVID-19 vaccines, testing, and treatment at no cost to the individual through the COVID-19 Uninsured Group Program. Beginning March 20, DHCS will send the individuals in this group a sunset notice in their preferred language with a copy of the “Application for Health Insurance” and a “Notice of Language Services.”
EMSA AND CDPH WAIVERS: CHA is seeking the extension of the California Department of Public Health (CDPH) and Emergency Medical Services Authority (EMSA) COVID-19 waivers from June 30 to Sept. 30. With a projected summer wave of COVID-19 threatening to strain an already stressed health care delivery system, these flexibilities are critical to maintaining the current health care capacity in California. Specifically, the waivers at risk are:
Both waivers will need an executive order to be issued by the governor’s office to update the most recent executive order’s provisions that otherwise will expire. CHA is advocating for these executive order provisions, and corresponding CDPH and EMSA waivers, to be renewed as soon as possible. CHA has developed talking points that hospitals may want to use in outreach to state legislators and department officials about the impacts to their communities if these flexibilities are not extended. HASD&IC submitted feedback from members to help with CHA’s advocacy efforts.
MEDI-CAL ELIGIBILITY FOR NEW UKRAINIAN ARRIVALS: The Department of Health Care Services (DHCS) has released a Medi-Cal Eligibility Division Information Letter to provide guidance to counties on the Medi-Cal eligibility of Ukrainian nationals arriving in California. It is anticipated that a significant number will resettle in California. The federal government has not provided any special benefit eligibility for this population, but has authorized the use of Temporary Protected Status (TPS) for Ukrainian arrivals who qualify. Many of the Ukrainian arrivals may enter under TPS or as humanitarian parolees and may not be eligible for the traditional federal services offered to immigrants granted refugee status. However, they may qualify for state-funded programs, including state-funded full-scope Medi-Cal. The letter provides guidance on how to establish Medi-Cal eligibility for this population (based on current Medi-Cal policy) for state and federal Medi-Cal benefits. DHCS will work closely with the state Office of Refugee Health and stakeholders to ensure that new Ukrainian arrivals receive the Medi-Cal benefits to which they are entitled.
COVID-19 VACCINATIONS BY ZIP CODE: San Diego County’s Weekly COVID-19 Surveillance Report shows the percentage (as of Dec. 4) of the total population of San Diego County residents who are fully vaccinated, by ZIP code of residence. Note that the data only include vaccines that have been recorded in the San Diego Immunization Registry. Some health care providers, including Veteran’s Affairs, the Department of Defense, some tribal entities, and prisons, do not report to the registry.
San Diego County Board of Supervisors Address Medi-Cal Managed Care: Lask week, HASD&IC President & CEO Dimitrios Alexiou provided public comment (testimony starts at 4:08) in support of the Framework for the Future: Improving the County’s Wellness Care Delivery System to Address Health Disparities Exacerbated by the COVID-19 Pandemic and shared the HASD&IC Board of Directors guiding principles for new Medi-Cal managed care contracts. He emphasized the importance of using this opportunity to prioritize patients, strengthen local oversight, and increase accountability. HASD&IC will continue to engage with supervisors on the Medi-Cal managed care procurement process.
Input Sought on County Budget: As the effort continues to build a framework for a more equitable, inclusive San Diego County, public input is needed for the 2021-22 budget process. On May 6, the county’s Chief Administrative Officer (CAO) will recommend a draft budget, and on May 26-27 county departments will present their draft budgets. The budget hearings set for June 14 and 16 are opportunities to suggest changes or additional funding needs. From June 14-23 the CAO and Board of Supervisors can request changes to draft budget. This period is the last opportunity to advocate for budget changes. Final budget deliberation and adoption is set for June 29.