​Program Updates

​Back to April 2022 Stakeholder Communications Update

Adverse Childhood Experiences (ACEs) Aware

On March 4, DHCS and the Office of the California Surgeon General, in partnership with the University of California, Los Angeles (UCLA)/University of California, San Francisco (UCSF) ACEs Aware Family Resilience Network (UCAAN), released a new data report detailing the number of ACE screenings conducted for children and adults in California between January 1, 2020, and March 31, 2021. The report also tracks the number of clinical team members that completed the “Becoming ACEs Aware in California" online training between December 4, 2019, and September 30, 2021.

During that period, more than 20,600 individuals took the ACEs Aware training, and about 10,900 providers became ACEs Aware-certified. Based on Medi-Cal claims data from January 2020 to March 2021, Medi-Cal providers conducted approximately 640,700 ACE screenings for nearly 520,000 unique Medi-Cal beneficiaries.

In addition, the report provides demographic information about beneficiaries who have been screened for ACEs, summarizes the characteristics of individuals who have completed the ACEs Aware training, and provides a breakdown of ACE screening rates by Medi-Cal MCP. The report and accompanying fact sheet are available on the ACEs Aware website.

Alternative Residential Model (ARM) Rate Methodology

On December 30, 2021, DHCS submitted Disaster Relief (DR) State Plan Amendment (SPA) 21-0031, on behalf of the California Department of Developmental Services (DDS), to the federal Centers for Medicare & Medicaid Services (CMS) for rate increases for providers reimbursed under the ARM rate methodology as a result of an increase to the state minimum wage. The DR SPA was approved by CMS on March 2, with an effective date of January 1 through March 31, 2022. Continued authority for this SPA is incorporated into SPA 21-0040 under a permanent authority within the 1915(i) State Plan.

Behavioral Health Continuum Infrastructure Program (BHCIP) Update

On January 31, DHCS, in partnership with the California Department of Social Services (CDSS), released the BHCIP: Round 3 Launch Ready and CDSS Community Care Expansion Program joint Request for Application (RFA). Eligible organizations for BHCIP Round 3: Launch Ready may apply and receive funding support to construct, acquire, and rehabilitate real estate assets in settings that serve Medi-Cal beneficiaries. For BHCIP, applications will only be accepted from projects that are determined to have been through a planning process, are ready for implementation, and will expand the behavioral health continuum. DHCS will award up to $518.5 million in grant funds for BHCIP Round 3: Launch Ready, and funding must be obligated by June 2024 and liquidated by December 2026. 

BHCIP Round 3: Launch Ready is comprised of two application parts to balance the needs of projects capable of immediate expansion with applicants that need more time to develop their application. This will offer applicants two potential deadlines for submissions. Any remaining funds not awarded in Part One will be available for Part Two applicants. The deadline was March 31 for all Part One applications and is May 31 for Part Two applications.

DHCS held a listening session on March 16 for BHCIP Round 4: Children and Youth. Through this fourth round of competitive grants, DHCS will award $480.5 million for children and youth-focused behavioral health infrastructure projects.  

DHCS was authorized through 2021 legislation to establish BHCIP and award $2.1 billion to construct, acquire, and expand properties and invest in mobile crisis infrastructure related to behavioral health. CDSS oversees the Community of Care Expansion program, which was established through Assembly Bill (AB) 172 (Chapter 20, Statutes of 2021) as a companion effort, totaling $805 million, and focused on the acquisition, construction, and rehabilitation of adult and senior care facilities that serve Supplemental Security Income/State Supplementary Payment and Cash Assistance Program for Immigrants applicants and recipients and other adults who are experiencing or at risk of homelessness.

For more information, please visit the BHCIP project website or email BHCIP@dhcs.ca.gov​.

Behavioral Health Federal Grants Update

On February 28, DHCS awarded $14 million to 34 Behavioral Health Justice Intervention Services (BHJIS) programs. Activities began in February 2022 and will conclude in February 2023.

The funding opportunity was open to public, private nonprofit, and tribal entities, and allowed them to request a minimum of $50,000 and no more than $700,000. Funds will be used to support collaborative planning, hiring, training, or contracting with behavioral health clinicians and/or peers to be embedded with law enforcement, emergency medical technicians, and other first responders during emergency responses, or for the integration of harm reduction, reentry support, and diversion strategies.

BHJIS is funded by the Coronavirus Response and Relief Supplemental Appropriations Act, awarded by the federal Substance Abuse and Mental Health Services Administration, and is administered by Advocates for Human Potential, Inc., which is assisting DHCS in overseeing and implementing BHJIS. For more information, please visit the BHJIS website or email BHJIS@ahpnet.com. 

California Advancing and Innovating Medi-Cal (CalAIM) Updates

Benefit Standardization

Effective January 1, 2023, all MCPs will be required to authorize and cover institutional long-term care (LTC) services as required by state and federal law in an appropriate LTC facility. Currently, LTC services are a full managed care benefit in County Organized Health Systems (COHS) and/or Coordinated Care Initiative (CCI) plans. In non-COHS and non-CCI counties, MCPs are responsible for the month of admission and the month following. This transition will standardize and reduce the complexity of the varying models of care delivery in California. Populations moving between counties will have the same experience when it comes to receiving services through a MCP. The integration of LTC into Medi-Cal managed care, in combination with the Enhanced Care Management (ECM) and Community Supports initiatives, as well as the statewide carve-in of dual eligibles in Medi-Cal managed care, will provide MCPs with the incentives and tools to provide the full range of LTC and home and community-based services in settings and with providers that align with member choices and needs.

DHCS drafted beneficiary notices with information on the transition, including information about Medi-Cal managed care, accessing care, where to go for help, how to choose a MCP, and more. DHCS will release the beneficiary notices for stakeholder review in April 2022.

Additionally, DHCS is engaging with stakeholders to discuss all aspects of the transition related to beneficiary and provider communication, LTC policies, network adequacy, continuity of care, and more. These stakeholder meetings will continue throughout 2022. 
 
Effective July 1, 2023, DHCS will carve out specialty mental health (SMH) benefits to Kaiser Permanente and Partnership HealthPlan in Sacramento and Solano counties. DHCS will inform MCPs and beneficiaries that SMH services will no longer be provided by these plans in these counties. DHCS will ensure continuity of care protections are in place for beneficiaries before transitioning from the MCPs to county mental health plans.

​Community Supports

On February 15, DHCS received updated Models of Care (MOCs) from MCPs implementing Community Supports in formerly Whole Person Care/Health Homes Program counties, including proposed networks and estimated capacities for services. The final component of the MOC refresh submission from MCPs implementing Community Supports in all other counties is due by April 15. Revised Community Supports elections will be posted on the DHCS website in mid-April. DHCS will continue to update Community Supports elections at least semi-annually, or if MCPs propose significant changes that merit a refresh. On March 2, DHCS released revised APL 21-017 with additional clarifying information on Community Supports. 

DHCS is also seeking stakeholder feedback by April 29 on the Billing and Invoicing Guidance and Member-Level Information Sharing Between MCPs and ECM Provider Guidance, including identifying additional areas where data standardization may be beneficial.

Contingency Management (CM) Program

California is launching the nation's first CM program in Medicaid for stimulant use disorder. Seven counties were approved to participate in phase one of the implementation, launching in July 2022. Twenty counties sent a letter of intent to participate in phase two, launching this fall. If all 27 counties participate as expected, more than 80 percent of Medi-Cal beneficiaries will live in counties with the CM pilot, which will run through March 2024. DHCS contracted with an independent evaluator to measure the success of the program. DHCS will begin orientation and training participating counties and providers soon. DHCS is actively recruiting a vendor to manage the incentive manager component of the program; applications from vendors were due on April 8. For more information, please visit the DHCS website. 

Mandatory Managed Care Enrollment Phase II

CalAIM mandatory managed care enrollment will standardize enrollment processes to help ensure populations moving between counties are subject to the same requirements. This will eliminate variances in benefits according to aid code, population, or geographic location. There are two phases to mandatory managed care enrollment: Phase I is complete as of January 1, 2022, and Phase II will include the transition of all dual populations to be mandatory for Medi-Cal managed care on January 1, 2023. This transition does not include beneficiaries with a share of cost or restricted scope.  Individuals in long-term care aid codes (dual and non-dual) will also be mandatory in Medi-Cal managed care.

DHCS drafted beneficiary notices with information on the transition, including information about Medi-Cal managed care, accessing care, where to go for help, how to choose a MCP, and more. DHCS will release the beneficiary notices for stakeholder review in April 2022. 

Transition to Statewide Coordinated Care Options for Dual Eligible Beneficiaries

Under CalAIM, DHCS will transition Cal MediConnect (CMC) and the Coordinated Care Initiative (CCI) to a MLTSS and Dual Eligible Special Needs Plan (D-SNP) structure. This policy is intended to help meet the statewide goals of improving care integration and person centered care, under both CalAIM and the California Master Plan for Aging (MPA). 

The CMC program is transitioning on December 31, 2022. Starting on January 1, 2023, CMC members will be transitioned to exclusively aligned enrollment (EAE) Dual Eligible D-SNPs and matching Medi-Cal MCPs. Under EAE, beneficiaries can enroll in a D-SNP for Medicare benefits and in a Medi-Cal MCP for Medi-Cal benefits, which are both operated by the same parent organization for better care coordination and integration.

The transition will happen in all seven CCI counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. Existing CMC plans and all Medi-Cal MCPs in these counties must implement EAE D-SNPs by January 1, 2023, to support this transition. 

DHCS drafted beneficiary notices with information on the transition, including information about Medi-Cal managed care, accessing care, where to go for help, how to choose a MCP, and more. The beneficiary notices are undergoing beneficiary testing, which will be completed by end of May 2022.  

Additionally, DHCS conducts various stakeholder meetings to discuss all aspects of the transition related to beneficiary communication, technical assistance impacted on any system changes, continuity of care, and more.

Dental Transformation Initiative (DTI)

In accordance with the Medi-Cal 2020 waiver extension, DTI concluded on December 31, 2021. Due to projected expenditures and to keep within federally authorized funding limits, DHCS has postponed Program Year 6 DTI incentive payment releases until further notice. The DTI Program Year 5 Final Report, covering services from January through December 2020, has been published on the DHCS website.

Developmental Disability Rate Study Model

On December 13, 2021, DHCS submitted SPA 21-0040, on behalf of DDS, to CMS to implement a 2019 Rate Study Model. Pursuant to Welfare and Institutions Code section 4519.8, DDS submitted a rate study addressing the sustainability, quality, and transparency of community-based services for individuals with developmental disabilities to the Legislature in March 2019. The SPA provides an incremental rate increase for specified services, and was posted for public notice for 30 days on October 27, 2021. CMS issued approval on March 1, with an effective date of April 1.

DHCS Home and Community-Based Services (HCBS) Spending Plan Initiatives Updates​​

Assisted Living Waiver (ALW) Expansion

On January 7, CMS approved DHCS' amendment to the ALW to add 7,000 slots to eliminate the current waitlist and expand waiver capacity. This amendment is retroactive to July 1, 2021. ALW providers are enrolling participants from the waitlist. DHCS will continue to work with stakeholders to ensure care coordination and transition as beneficiaries are enrolled in ALW.

The ALW is designed to assist Medi-Cal beneficiaries to remain in their communities as an alternative to long-term placement in a nursing facility. Adding 7,000 slots to ALW will help in the effort to eliminate the ALW waitlist while promoting the vision of the Master Plan for Aging. The proposed addition of 7,000 slots will enable DHCS to provide sufficient ALW capacity to enroll all waitlisted beneficiaries and to clear pending enrollments while still providing capacity for continued growth.

CalBridge Behavioral Health Program

Since April 2019, the CalBridge Behavioral Health Program has reported 94,574 substance use navigator encounters, with 32,204 encounters where Medication Assisted Treatment (MAT) was prescribed or administered. Through HCBS, DHCS is contracting with the Public Health Institute (PHI) for $40 million to expand the reach of the program and the role of the navigator to better address mental health conditions as well as substance use disorders. To allocate the funds, PHI will release a RFA in April to solicit participation by hospitals, health systems, hospital foundations, or physician groups. 

Dementia Aware and SB 48 Implementation

As part of the HCBS Spending Plan, DHCS is developing the Dementia Aware initiative that will leverage $25 million in one-time enhanced federal funding to establish a statewide provider training program in culturally competent dementia care as well as develop a referral protocol on cognitive health and dementia.

Aligned with this initiative, Senate Bill (SB) 48 (Chapter 484, Statutes of 2021), establishes an annual cognitive health assessment as a Medi-Cal-covered benefit, available to Medi‑Cal‑only beneficiaries who are age 65 years or older and otherwise ineligible for a similar assessment under Medicare. SB 48 makes a Medi-Cal provider eligible to receive payment for this benefit only if the provider completes Cognitive Health Assessment (CHA) training as specified by DHCS. The target implementation date for this benefit, subject to an appropriation by the Legislature for this purpose, is July 1, 2022.

DHCS is executing a contract with UCSF to launch the Dementia Aware training and related activities. By July 1, DHCS, in partnership with UCSF and Dementia Aware's Clinical Advisory Board, will develop a high-quality, evidence-based online training to educate providers on using the CHA and implementing it into their practices. The Clinical Advisory Board will be comprised of stakeholders from a variety of primary care practice types and settings, community-based organizations serving people living with dementia and their caregivers, and experts in dementia care from the University of California campuses, California Alzheimer's Disease Centers, California Department of Public Health's Alzheimer's Disease Program, and Alzheimer's Disease and Related Disorders Advisory Committee of the California Health & Human Services Agency (CalHHS). UCSF will also create a toolkit for care planning once dementia is diagnosed and provide practice-support coaching to assist providers in effectively implementing the CHA and toolkit.

Housing and Homelessness Incentive Program (HHIP)

On March 30, DHCS held its third stakeholder meeting to provide program design updates, including refinements of performance measures based on solicited feedback received in March. All Medi-Cal MCPs that are eligible to participate in the HHIP submitted Letters of Intent to DHCS by April 4. DHCS is working to finalize program reporting templates, including the Local Homelessness Plan (LHP), create funding allocations, and issue an APL by the end of April. Participating MCPs are required to submit their LHP to DHCS by June 30. Materials from previous meetings and program documents are or will be available on the DHCS website. For questions or comments related to HHIP, please email DHCSHHIP@dhcs.ca.gov.

Non-In Home Supportive Services (IHSS) HCBS Care Economy Payments

In April, DHCS will release a Request for Information (RFI) to identify a contractor to assist DHCS in identifying eligible recipients and to implement systems to process payments. The identification of eligible recipients and payment processes will be complex and likely will require a mix of fiscal intermediary facilitated payments and DHCS direct payments due to mix of programs, normal program payment mechanisms (e.g., fee-for-service (FFS), capitation), and provider model (in most cases provider agencies claim or receive capitated payment for services provided by employed direct care staff). DHCS, in collaboration with sister departments and stakeholders, is working to identify a contractor with the appropriate skills, experience, and capacity to identify eligible recipients and implement systems to process payments. DHCS plans to identify and on-board a contractor by June, with work beginning in July. Processing of the incentive payments will begin no later than December 2022.

This initiative, approved through California's HCBS Spending Plan, will provide a one-time incentive payment of $500 to each current direct care, non-IHSS provider of Medi-Cal home and community-based services during the specific timeframe of at least two months between March 2020 and March 2021. This proposal will expand access to providers and could increase retention of current providers, covering 25,000 direct care HCBS providers in the Multipurpose Senior Services Program (MSSP) waiver, Community-Based Adult Services (CBAS) program , Home and Community-Based Alternatives (HCBA) waiver, ALW, HIV/AIDS waiver, Program of All-Inclusive Care for the Elderly (PACE), and the California Community Transitions (CCT) program, and would focus on payment for retention, recognition, and workforce development. This effort can help alleviate financial strain and hardships suffered by California's HCBS direct care workforce, which were worsened by the COVID-19 PHE. The PHE has exacerbated the direct care workforce shortage, driven by high turnover and limited opportunities for career advancement. This proposal, coupled with California's other proposals, can lead to a more knowledgeable, better trained, and sufficiently staffed HCBS workforce to provide high-quality services

Statewide HCBS Gap Analysis and Multiyear Roadmap RFI Release

On March 14, DHCS released a RFI soliciting information from interested parties to assist DHCS in launching a major project to conduct a statewide Gap Analysis and Multiyear Roadmap of California's HCBS and Managed Medi-Cal Long-Term Supports and Services (MLTSS) programs and networks. 

DHCS is seeking a contractor suited to meet the goals of the Money Follows the Person (MFP) Supplemental Funding – Gap Analysis and Multiyear Roadmap. DHCS will make a determination based on the contractor's capacity and expertise needed to conduct such a large-scale analysis of California's HCBS and MLTSS programs' participants, services, providers, and systems of care. Proposals from interested parties were due by April 8. DHCS will make the contract award in June, with the contractor beginning work in July. Submission of the gap analysis will occur by September 30, 2023, and the multiyear roadmap will be submitted by March 31, 2024. DHCS will present final deliverables to stakeholders and legislators by June 30, 2024.

This effort includes measure recommendations to inform the LTSS Data Transparency initiative, part of the HCBS Spending Plan. This initiative will launch an LTSS data dashboard that brings together utilization, quality, and cost data from long-term care institutional and congregate settings, home and community-based services, in-home supports and services, and services for individuals with developmental disabilities. Given the aligned objectives between the MFP Supplemental Funding and the LTSS Data Transparency initiative, DHCS included a deliverable in the MFP Gap Analysis and Multiyear Roadmap RFI for the vendor to provide by January 2, 2023, recommendations and

Medi-Cal Health Enrollment Navigators Project

Health enrollment navigator services are more critical than ever because of the community health impacts of COVID-19. Under AB 74 (Chapter 23, Statutes of 2019), $59.7 million was appropriated to DHCS to partner with counties and community-based organizations (CBOs) to conduct Medi-Cal outreach, enrollment, retention, and navigation services for hard-to-reach Medi-Cal and potentially eligible Medi-Cal populations. Project partners have implemented innovative and creative approaches to contact and enroll eligible populations in their local communities, provided vaccine information and outreach at the local level, and engaged college students at all levels. The current phase of the project allows CBOs and counties to incorporate new or expand existing activities for all participants, and continue adjusting their outreach and enrollment approaches to overcome challenges presented by COVID-19. As of March 2022, seven partners have requested and received additional funding. Information and updates related to the project are available on the DHCS website.

Medi-Cal Rx Implementation Update

With the transition of the Medi-Cal pharmacy benefit to a single delivery system, there were significant implementation challenges, such as long call center wait times and delays in processing prior authorizations. In early February, DHCS and Magellan (the Medi-Cal Rx contractor) implemented a prior authorization temporary mitigation strategy and aggressive staffing plan, with the goal of accelerating the turnaround time on prior authorization requests and reducing call volume into the call center managed by Magellan. DHCS also brought its state call center online to assist with calls and designated state staff to assist with prior authorization processing. These strategies have resulted in processing levels improving significantly.

DHCS is also ensuring that providers are kept updated and that relevant information is communicated to them via e-mail blasts, provider newsflashes, information on the DHCS and Medi-Cal Rx websites, and direct provider outreach. These actions are designed to ensure that Medi-Cal members can get the prescription drugs they need when they need them. For questions or comments related to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.  

Smile, California Campaign for Medi-Cal Dental Services

In March, Smile, California launched the Molar Sealant March promotion to educate parents and caregivers about molar sealants, remind them that sealants are a covered benefit for children, and motivate them to make an appointment with their children's dentist to have sealants applied. Molar sealant landing pages were created on both SmileCalifornia.org and SonrieCalifornia.org to offer educational resources and videos.  Weekly social media posts ran on the Smile, California Facebook and Instagram pages, which featured questions and answers about molar sealants and directed users to learn more and find a dentist on SmileCalifornia.org.

On March 10 and 11, Smile, California hosted two Facebook Live events for Medi-Cal members, one in English and one in Spanish. Presenters provided an overview of Medi-Cal Dental benefits, answered Medi-Cal member questions about their dental benefits, and reviewed frequently asked questions.

At the end of February, SmileCalifornia.org and SonrieCalifornia.org had 63,132 new visitors, of which 46,032 clicked the “Find a Dentist" button.

Temporary Extension of the HCBA Waiver and HIV/AIDS Medi-Cal Waiver Program (MCWP)

On December 22, CMS approved DHCS' request to extend the current terms of the HCBA and MCWP waivers for 90 days. Both waiver terms were scheduled to expire on December 31, 2021, and the initial temporary extension allowed the waivers to continue through March 31, 2022. Because CMS did not complete their review of the waiver renewal applications by March 31, 2022, DHCS submitted a new request to extend the term of the waivers for an additional 90 days, through June 30, 2022. Additionally, the renewal application proposes to change the name of the HIV/AIDS MCWP to MCWP in order to respect the privacy and confidentiality of waiver participants.

The extension provides CMS with additional time to review the HCBA waiver and MCWP renewal applications, and allows the state time to respond to CMS' questions and submit a revised waiver renewal application.
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