​​DHCS Stakeholder Update - March 17, 2023

​Top News

New DHCS Federal Request on Asset Flexibility During Continuous Coverage Unwinding

On March 10, DHCS submitted a waiver flexibility request to the Centers for Medicare & Medicaid Services (CMS) to support the unwinding of the continuous coverage requirement. The Section 1902(e)(14)(A) waiver flexibility seeks to make it easier for Non-Modified Adjusted Gross Income (MAGI), for example seniors and persons with disabilities, to renew their Medi-Cal coverage—and remain covered until California eliminates the asset limit on January 1, 2024. It will allow counties to use existing case file information to grant eligibility during renewals, and disregard any increases in assets since the last Medi-Cal determination. Also, for individuals who were not initially subject to an asset test at the time of their Medi-Cal application, but have now transitioned into a program requiring one, the waiver flexibility would allow California to renew based on their last known eligibility determination on file. DHCS is requesting this authority to be effective retroactive to March 1, 2023, and remain in effect through December 31, 2023.

The requested waiver flexibility only applies to Medi-Cal renewals and not to new applications. New Medi-Cal applications, specifically for Non-MAGI programs, are still subject to the asset test until it is eliminated. The asset test for new Medi-Cal non-MAGI applications was raised to $130,000 per individual and $65,000 per additional person on July 1, 2022. It is important to note that non-MAGI Medi-Cal members will still need to meet all other Medi-Cal eligibility criteria, including income, to remain Medi-Cal eligible at redetermination.

Once CMS approves, DHCS would issue immediate guidance to counties via a Medi-Cal Eligibility Division Information Letter. 

Program Updates

2024 Expansion of Medi-Medi Plans to Additional Counties

Starting January 1, 2024, DHCS will expand the availability of Medi-Medi Plans for dual eligible Medicare and Medi-Cal members to five additional central valley counties: Fresno, Kings, Madera, Sacramento, and Tulare. Medi-Medi Plans for dual eligible Medicare and Medi-Cal members are currently available in the seven former Coordinated Care Initiative (CCI) counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.

Medi-Medi Plans is the California-specific program name for Medicare Advantage Exclusively Aligned Enrollment Dual Eligible Special Needs Plans (D-SNPs). Under Medi-Medi Plans, dual eligible members can voluntarily enroll in a D-SNP for Medicare benefits and in a Medi-Cal managed care plan (MCP) for Medi-Cal benefits, which are both operated by the same parent organization for better care coordination and integration.

DHCS is meeting with local stakeholders in the five expansion counties to provide more information about Medi-Medi Plans, and will include this topic in future meetings of the Managed Long-Term Services & Supports & Duals Integration Workgroup. More information about Medi-Medi Plans is available on the Medicare Medi-Cal Plans webpage. Please email OMII@dhcs.ca.gov with any questions.​​​

Health Enrollment Navigators Project​

The Navigators Project recently made webpage updates to provide more targeted information for advocate and stakeholder communications, project partners, and general announcements/other communications. The project partners webpage also includes specific information related to the Senate Bill (SB) 154 funding awards, a list of local community-based organizations and subcontracted entities by county, and the Project Partner Summary, which details high-level work efforts, such as enrollment and retention goals, funding amounts, subcontractors, and target populations being served.

Federal Approval of Mpox Vaccine Administration for Clinics

CMS recently approved a State Plan Amendment (SPA) to reimburse vaccine-only encounters at the fee-for-service (FFS) rate at certain clinics, retroactive to August 17, 2022. SPA 22-0062 pertains to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHCs), Indian Health Services Memorandum of Agreement (IHS-MOA), and Tribal FQHC clinic providers.

Effective March 10, 2023, FQHC, RHC, IHS-MOA, and Tribal FQHCs may submit claims for members enrolled in Medi-Cal managed care for Mpox vaccine-only encounters. Likewise, claims for FFS members may be submitted by FQHC, RHC, IHS-MOA, and Tribal FQHC providers using the instructions published in the December 13, 2022, article “Mpox Vaccines Reimbursement at the Medicare Rate".

This reimbursement policy is effective for dates of service on or after August 17, 2022, through January 31, 2023, the end of the Mpox state public health emergency (PHE). At the conclusion of the PHE, the reimbursement rates for Mpox vaccine administration returned to the Medi-Cal FFS rates in effect at that time. Providers are reminded that each administration of the Mpox vaccine falls under a qualifying office visit or vaccine-only encounter, not both.

FQHC, RHC, IHS-MOA, and Tribal FQHC providers will receive a 120-day timeliness override to submit the Mpox vaccine-only encounters.

Traditional Indian Health (TIH) Request for Application (RFA) Release

During the week of March 20, DHCS anticipates the release of a RFA to fund three TIH education programs that will assist Indian clinics in providing services to American Indians in a culturally appropriate manner and to provide a forum for the Indian community to address TIH education. A total of $300,000 is available to fund regional TIH programs for two fiscal years. This funding opportunity supports the provision of traditional Indian health care. Funds for this project are part of the $11,576,000 allocated in the fiscal year 2022-23 budget for the restoration of Indian Health Program grant programs.

It is anticipated that $100,000 per region will be made available to support each regional program for two fiscal years. The maximum funding is $50,000 per region per fiscal year. The grant term is projected to start in May 2023 and continue through June 30, 2024.

For questions about the RFA, please email TribalAffairs@dhcs.ca.gov.

Join Our Team 

DHCS is hiring for our fiscal, human resources, legal, auditing, health policy, and information technology teams. For more information, please visit the CalCareers website.  

DHCS is dedicated to preserving and improving the overall health and well-being of all Californians. DHCS' mission is to provide the most vulnerable residents with equitable access to affordable, integrated, and high-quality health care, and is currently transforming the Medi-Cal program to make sure it provides the care Californians need to live healthier, happier lives. 

Upcoming Stakeholder Meetings and Webinars

California's Reproductive Health Access Section 1115 Demonstration: Tribal and Designee of Indian Health Programs Webinar

On March 20, from 9 to 10 a.m., DHCS will host a Medi-Cal Tribal and Designee of Indian Health Programs webinar (advance registration required) to provide information and receive feedback on California's Reproductive Health Access Demonstration (CalRHAD) 1115 request in advance of DHCS' submission to CMS. Tribal partners have been invited to participate in the webinar via email.

California's Reproductive Health Access Section 1115 Demonstration: First Public Hearing

On March 29, from 10 to 11 a.m., DHCS will host the first (advance registration required) of two public hearings to solicit stakeholder comments on a proposed CalRHAD Medicaid Section 1115 demonstration. DHCS is seeking approval from CMS to provide competitive grants to reproductive health providers to enhance capacity and access to sexual and reproductive health services, promote the sustainability of California's reproductive health provider safety net, and benefit individuals enrolled in Medi-Cal and other individuals who currently face barriers to such access.

Screening and Transition of Care Tools Informational Webinar

On March 29, from 3 to 4 p.m., DHCS will hold a Screening and Transition of Care Tools webinar (advance registration required) to discuss the Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services, which went live on January 1, 2023, as part of California Advancing and Innovating Medi-Cal (CalAIM). This initiative is focused on implementing statewide screening and transition of care tools for both adults and individuals under 21 years old for use by Medi-Cal MCPs and county mental health plans. The webinar will include an overview of the purpose of the initiative, a discussion on notable requirements and case examples, and responses to frequently asked questions. For more information, please visit the Screening and Transition of Care Tools webpage.

Children and Youth Behavioral Health Initiative (CYBHI) Monthly Public Webinar: March 2023