Medi-Cal

About Medi-Cal

Every year, California’s hospitals treat millions of patients, many of them covered by Medi-Cal, the state’s health care safety net. This includes numerous essential health care services for Californians, including care for more than 50% of all births, 46% of behavioral health-related emergency department visits, 58% of rural hospital patient care days, 1 million inpatient stays, and nearly 16 million outpatient visits in 2018. CHA is committed to protecting Medi-Cal rates and assuring that the state’s neediest maintain access to the high quality of care that all Californians deserve.

5 Things To Know: Medi-Cal Fraud Prevention Training, Retention Payment Program, Behavioral Health Funding Opportunities, Skilled-Nursing Facilities, Community College Instructors Needed

MEDI-CAL FRAUD PREVENTION TRAINING: The Department of Health Care Services Investigations Division will join HASD&IC for a webinar on Nov. 8 from 10 a.m. to noon (PT) to provide Medi-Cal Fraud Prevention Training. The main objective of this training is to help preserve professional ethics and integrity to ensure that Medi-Cal benefits and other public program benefits are provided only to eligible persons. Attendees will hear potential fraud indicators and appropriate actions to take if they do encounter a suspicious situation. This training opportunity is highly encouraged for any hospital or vendor staff who assist patients with their Medi-Cal application and is a great opportunity to ask any questions about Medi-Cal fraud concerns. Please pass along the invitation to any staff and colleagues who would be interested in attending.

5 Things To Know: Imperial County, Reminder — CDPH Leadership Updates and District Session, Addressing Homelessness, MEDICARE MEDI-CAL Plans (MMPS), Loan Repayment and Scholarship Program Application Cycles

IMPERIAL COUNTY: Larry Lewis, who has been Pioneers Memorial Healthcare District CEO since 2012, has been hired to lead the Imperial County Local Health Authority. The announcement was made at the commission meeting on Oct. 10. He will assume responsibilities with the health authority on Nov. 14. We thank Larry for his years of service on the HASD&IC board and for his leadership at Pioneers to enhance the health and well-being of Imperial County communities. We wish him the best in his next endeavor and look forward to working with him in his new role.

5 Things To Know: Medi-Cal Managed Care Contract Appeals, HQI Annual Conference, Behavioral Health, New Homeless Shelter, and Medical Device Vulnerability

MEDI-CAL MANAGED CARE CONTRACT APPEALS: Aetna Better Health of California, Blue Shield of California Promise Health Plan, Community Health Group, and Centene Corporation have all appealed the Department of Health Care Services’ notice of intent to award Medi-Cal Managed Care contracts in San Diego County. Health Net — owned by Centene — was awarded contracts in a number of counties, it is protesting its absence from Los Angeles County. In its appeal, Health Net contends that its historical presence and work providing Medi-Cal in the region merits its continued provision of managed care in the county.

5 Things To Know: Behavioral Health Hub, GED Accreditation, ICYMI – Medical Baseline Customers, MonkeyPox, and Medi-Cal Enrollment

BEHAVIORAL HEALTH HUB: Last week, the San Diego County Board of Supervisors unanimously approved a plan for a less-expensive behavioral health facility at Alvarado Hospital Medical Center. When it opens in late 2023, the Central Regional Behavioral Health Hub will feature 44 new acute inpatient beds and a crisis stabilization unit. The county is also looking at other opportunities to expand other continuum capacities at sites such as the Rosecrans and Parcel/Third Avenue psychiatric facilities. Under the plan, Alvarado Hospital is the license holder/operator; UCSD will provide medical direction, clinical oversight, and clinical training capacity; and the county will be the capital investor, staffer, and payer. Plans call for investing capital in the project with expectations that future capacity will increase to 60 beds total.

The discussion will be continued at future Board of Supervisors meetings. On Sept. 27, Luke Bergmann, PhD, behavioral health services director for San Diego County’s Health and Human Services Agency, will present an analysis of the urgent needs of different service areas (post-acute and long-term care). On Oct. 11, Dr. Bergmann will present a report on concrete action to expand capacity in identified areas.  

5 Things To Know: Workforce, Health Equity Webinars, Behavioral Health, Scholarship and Loan Repayment Programs

WORKFORCE: The San Diego Workforce Partnership recently launched the Healthcare Administration Pathways Program. This program will put participants with no health care experience (but preferable experience in hospitality or retail) through the UC San Diego (UCSD) Division of Extended Studies Revenue Cycle and Management Intensive Course at no cost to them. The partnership is working with UCSD, Rady’s Children’s Hospital, and Scripps Health to fill patient access representative I positions in hopes of diversifying the pipeline of workers. Participants who complete the course will also be eligible to sit for the certified revenue cycle specialist exam, which the workforce partnership will also fund. The San Diego Workforce Partnership is looking to expand partnerships with more hospitals in the region for this program. 

5 Things To Know: CalAIM Incentive Payment Plan, Retention Payment Program, Monkeypox Resources

CALAIM INCENTIVE PAYMENT PLAN PROGRAM UPDATE: The California Advancing and Innovating Medi-Cal (CalAIM) Incentive Payment Program is intended to support the implementation and expansion of enhanced care management and community supports by incentivizing managed care plans (MCPs) to drive MCP delivery system investment in provider capacity and delivery system infrastructure. It is also intended to bridge current silos across physical and behavioral health care service delivery; reduce health disparities and promote health equity; achieve improvements in quality performance; and encourage take-up of community supports. More information on the MCP Incentive Payment Plan Program Year 1 Gap Filling Plan is available by county (San Diego and Imperial included) on the Department of Health Care Services website. Additional general information on the Incentive Payment Program can be found on the CalAIM Roundtables by Region web pages for San Diego and Imperial counties. 

5 Things To Know: AFL on Infant Formula, EMSA and CDPH Waivers, Alzheimer’s Awareness Month

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.

5 Things To Know: Medi-Cal Eligibility, National Hospital Week, Rural Floor Court Ruling

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.

5 Things To Know: Medi-Cal Expansion, HASD&IC Partnership Championed, Youth Drug Webinar

IMPERIAL VALLEY HOMELESSNESS: At the April 12 Imperial County Board of Supervisors meeting, the Imperial Valley Continuum of Care Council Administrative Entity provided details of how they are addressing homelessness and overall accomplishments so far. Updates include a redesign of an operating Coordinated Entry System, the entity’s pandemic response (a region-wide survey to understand needs), update on current continuum of care programs, and projects such as the new Homeless Day Center that will provide services to over 700 individuals per year, Lotus Living Community (transitional housing) for Imperial Valley College students, and youth programs for those experiencing homelessness that have served 156 youth.