Program Updates
Back to June 2022 Stakeholder Communications Update
Asset Limits – Non-Modified Adjusted Gross Income (MAGI) Medi-Cal
Assembly Bill (AB) 133 (Chapter 143, Statutes of 2021) authorizes a two-phased approach to eliminating the asset test for all non-MAGI Medi-Cal programs, including long-term care and the Medicare Savings Programs. Phase I will be implemented on July 1, and will increase asset limits to $130,000 per person and $65,000 per additional person being evaluated. Phase II will be implemented on January 1, 2024, and will eliminate the asset test. In November 2021, CMS approved State Plan Amendment 21-0053, and DHCS issued policy guidance to the counties regarding the Phase I implementation in an All County Welfare Directors Letter (ACWDL 21-31). DHCS has also submitted to CMS an application to amend the CalAIM Section 1115 demonstration waiver to permit California to increase, and eventually eliminate, the asset test for the Supplementary Security Income deemed coverage groups. DHCS published Medi-Cal Eligibility Division Information Letter (MEDIL I 22-02), which provides counties, advocacy groups, and other partners with global outreach messaging to use in their outreach activities regarding the increased asset limits as of July 1.
Behavioral Health Continuum Infrastructure Program (BHCIP) Update
BHCIP Round 3: Launch Ready
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 (CCE) Program joint Request for Application (RFA). Applicants were invited to apply for either funding opportunity or both. The deadline for BHCIP Round 3: Launch Ready applications was April 8, and application reviews are underway, with applicants requesting approximately $2 billion. DHCS expects to announce BHCIP Round 3: Launch Ready awards in June.
BHCIP applicants were required to demonstrate project expansion with the behavioral health continuum of treatment and services in settings that serve Medi-Cal beneficiaries, and have a valid planning process to ensure projects are ready for implementation. 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 4: Children and Youth
BHCIP Round 4: Children and Youth focuses on children and youth age 25 and younger, including pregnant and postpartum people and their children, children, and transition-age youth (TAY), as well as their families. All applicants will need to demonstrate how their infrastructure project will expand behavioral health services for this population exclusively. Through this fourth round of competitive grants, DHCS will award $480.5 million for children and youth-focused behavioral health infrastructure projects.
The RFA for Round 4: Children and Youth was released on June 1. DHCS has released a program update as a supplement to the upcoming RFA for BHCIP Round 4: Children and Youth funding. As was the case with Round 3: Launch Ready, applicants are required to undergo a pre-application consultation. They will be expected to demonstrate “project readiness", as detailed in the forthcoming RFA, and will be funded according to which of three pre-construction phases their project is in. Full project funding will be contingent upon completion of all three phases of development planning.
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 CCE program, which was established through AB 172 (Chapter 20, Statutes of 2021) as a companion effort, totaling $805 million. The CCE program focuses 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
DHCS recently submitted its Year 2, Mid-Year State Opioid Response (SOR) II progress report to its federal funder, the Substance Abuse and Mental Health Services Administration. Between September 2021 and March 2022, the SOR grant supported treatment services for 21,672 individuals with opioid use disorder. Of those, more than 16,000 received buprenorphine, 5,000 received methadone, and 400 received injectable naltrexone. SOR also supported recovery or peer coaching for more than 30,000 individuals, recovery housing services for more than 1,600 individuals, and employment services for nearly 1,500 individuals. During this period, SOR supported the Naloxone Distribution Project, leading to more than 9,000 opioid overdose reversals. Additionally, SOR funded stimulant use disorder treatment services for more than 5,600 individuals.
For more information about the SOR grant, please visit the Medication Assisted Treatment Expansion Project webpage or email DHCSMATExpansion@dhcs.ca.gov.
Behavioral Health Quality Improvement Program (BHQIP)
The Department of Health Care Services (DHCS) created a three-year Behavioral Health Quality Improvement Program (BHQIP) to support implementation of the CalAIM initiative. The CalAIM BHQIP is structured as an incentive program, whereby counties may earn incentive payments by achieving certain CalAIM implementation milestones. Senate Bill (SB) 129 (Chapter 69; Statutes of 2021), authorized $21,750,000 in General Fund dollars for the CalAIM BHQIP for Fiscal Year 2021-22, which included a startup allocation amount of $250,000 to each county behavioral health plans participating in BHQIP, and the rest was allocated to counties based on each county's share of statewide claims value reported to DHCS. For inquiries about BHQIP, please contact BHQIP@dhcs.ca.gov.
CalAIM Updates
Community Supports
On April 15, DHCS received final updated Models of Care (MOCs) from Medi-Cal MCPs implementing Community Supports in all 58 California counties, including proposed networks and estimated capacities for services. On July 1, MCPs will proceed with the next phase of implementation of Community Supports and bring on additional Community Supports services elected through the MOC process. Revised Community Supports elections will be posted on the CalAIM webpage in mid-June, once DHCS has approved all outstanding MCP MOCs. DHCS will continue to update Community Supports elections at least semi-annually.
Enhanced Care Management (ECM)
ECM was implemented in counties with Health Homes Programs (HHP) and Whole Person Care (WPC) pilots on January 1, 2022. On July 1, 2022, counties that did not have HHP and WPC programs will begin implementation of ECM for the following Populations of Focus (POF): individuals and families experiencing homelessness, adult high utilizers, and adults with serious mental illness (SMI) or substance use disorder (SUD). DHCS is reviewing each MCP's policies and procedures and confirming provider networks are ready for implementation.
Also, to ensure operational readiness, MCPs will submit updated MOCs by July 1 for two long-term care (LTC) POFs (members eligible for LTC and those at risk of institutionalization; and nursing home residents transitioning to the community), scheduled to go-live on January 1, 2023.
Population Health Management (PHM)
On May 3, DHCS released the Draft PHM Strategy and Roadmap for public comment, and written comments were due on May 16. This document describes DHCS' vision for PHM, outlining key policy initiatives and accountability mechanisms, defining and describing PHM concepts and terminology, and detailing requirements for Medi-Cal MCPs for 2023 and 2024. On May 9, DHCS issued an Invitation for Proposal (IFP) for the PHM Service, and anticipates awarding a contract to the selected vendor by this summer.
Providing Access and Transforming Health (PATH)
In June, the first round of application submissions for the PATH Collaborative Planning participants and facilitators, Justice-Involved Capacity Building, and the Capacity and Infrastructure Transition Expansion and Development (CITED) initiative will begin. DHCS completed the IFP procurement for the PATH Third Party Administrator (TPA) in May. DHCS is evaluating the proposals and aims to award the TPA vendor contract by the end of June. DHCS continues to develop and finalize the guidance documents for the Technical Assistance Marketplace, Collaborative Planning, CITED, and Justice-Involved Capacity Building initiatives. Visit the CalAIM PATH Initiative webpage for current information and resources on PATH initiatives.
CalHOPE
CalHOPE has continued providing Crisis Counseling Assistance and Training Program (CCP) services to Californians in need of support. CalHOPE was approved for a 30-day and a 60-day cost extension that allowed CCP services through May 10, 2022. The federal partners recently approved DHCS' 90-day no-cost extension, extending CalHOPE CCP services through July 9, 2022 and administrative close out activities through August 10, 2022.
CalHOPE continues to provide CCP educational services to schools, raising awareness of the negative effects of anxiety. CalHOPE has been partnering with IndieFlix since October 2021, including releasing the film ANGST: Building Resilience, which is based on a mental health support program. The outreach has been successful, as more than 150 school districts registered, multiple in-person Angst screenings were conducted in schools, and outreach/communication to other venues have been scheduled. Additionally, All It Takes, in partnership with CalHOPE and the California Department of Education, has received positive feedback after the release of the film, A Trusted Space, which is aimed at training educators on how to help mitigate the effects of emotional stressors on students and their families.
DHCS' service provider, California Consortium of Urban Indian Health (CCUIH), has remained engaged in outreach of CCP services to their Tribal community. CCUIH has tabled various indigenous events, such as the Stanford Pow Wow, Mariposa Pow Wow, Indigenous Red Markets, and Healing and Coping events, sharing resources of the CalHOPE RedLine.
Community Mental Health Equity Project (CMHEP)
DHCS, in partnership with the California Department of Public Health, is providing support to CBOs and county behavioral health departments through CMHEP to implement population-specific and community-driven approaches. AB 74 (Chapter 23, Statutes of 2019) authorized funding to provide training and technical assistance to county behavioral health departments. CMHEP efforts will cover two years. DHCS hired the Center for Applied Research Solutions to develop statewide community-driven policy guidance, along with strategies and interventions aimed at reducing disparities in access to health and behavioral health care. A robust data collection framework to evaluate improvements in access to culturally responsive care will accompany the newly developed policy guidance. For more information, visit the CMHEP website.
DHCS Home and Community-Based Services (HCBS) Spending Plan Initiative
CalBridge Behavioral Health Program
As of February 2022, the Public Health Institute/CA Bridge (PHI) has reported 112,474 patients seen by a substance use navigator, 90,593 patients identified with an opioid use disorder and 40,044 patients provided with medication assisted treatment. Through the Home and Community-Based Services, DHCS is contracting with the 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 through the CalBridge Behavioral Health Navigator Program. To allocate the funds, PHI released a Request for Application RFA in April 2022 to solicit participation by hospitals with emergency departments, health systems, hospital foundations, or physician groups.
For more information about the CalBridge Behavioral Health Navigator Program, please visit the Bridge Navigator Program website.
Older Adult Full-Scope Medi-Cal Expansion
On May 1, individuals 50 years of age or older who met all Medi-Cal eligibility criteria, and who do not have satisfactory immigration status for federally-funded full-scope Medi-Cal, became newly eligible for state-funded full-scope Medi-Cal under the Older Adult Expansion. DHCS successfully transitioned 247,522 existing Older Adult Expansion individuals in restricted scope Medi-Cal to full-scope Medi-Cal, effective May 1. Individuals who apply now will automatically be determined eligible for full-scope Medi-Cal if they are 50 years of age or older and meet all other Medi-Cal eligibility criteria, regardless of immigration status. This expansion of Medi-Cal supports the Newsom Administration's vision of a Healthy California for All by addressing health coverage disparities that disproportionately impact disadvantaged communities.
Peer Support Services
On May 2, DHCS received CMS approval of SPA 22-0024, with an effective date of July 1, to broaden the definition of a Peer Support Specialist as someone who must be in recovery themselves or have lived experience with the process of recovery as a parent, caregiver, or family member. Prior to this update, Peer Support Specialists were defined solely as individuals in recovery, which excluded parents, caregivers, or family members from becoming certified as Peer Support Specialists. This update aligns the definition of Peer Support Specialist with the Medi-Cal Peer Support Specialist Certification Program requirements.
On May 6, DHCS issued Behavioral Health Information Notice (BHIN) 22-026, which provides guidance regarding the submission of an opt-in letter and claiming requirements for Peer Support Services in the Drug Medi-Cal (DMC), Drug Medi-Cal Organized Delivery System (DMC-ODS), and Specialty Mental Health Services (SMHS) programs. In order to implement Peer Support Services effective July 1, counties must have provided a letter to DHCS stating their request to opt in to provide peer support services, and indicating the program(s) (SMHS, DMC-ODS, and/or DMC) for which they are opting in. The letter must be signed by the Behavioral Health Director and emailed to CountySupport@dhcs.ca.gov by May 20 to implement peer support services, effective July 1. To date, 48 counties have submitted a signed letter stating their request to opt in to provide Peer Support Services effective July 1, 2022, with most counties opting to cover Peer Support Services in both their SMHS and their DMC or DMC-ODS programs.
Counties that are unable to elect to opt in to provide Peer Support Services by the May 20 deadline will still have opportunities to opt in every six months. DHCS will provide additional information about subsequent opportunities for opting in to provide Peer Support Services in the future.
Provider Application and Validation for Enrollment (PAVE) Portal for Dental Providers
DHCS will implement the PAVE portal for dental providers in fall 2022. The PAVE portal is a web-based application designed to simplify and accelerate enrollment processes. PAVE will provide a new mode for submitting dental provider enrollment applications and required documentation to DHCS, allowing applicants to use an electronic form called the Medi-Cal Provider e-Form Application. DHCS will no longer accept paper applications once PAVE is implemented.
Smile, California Campaign for Medi-Cal Dental Services
SmileCalifornia.org, SonrieCalifornia.org, and all materials pertaining to pregnant members were updated to reflect the American Rescue Plan Act of 2021 Postpartum Care Extension policy that was enacted on April 1, 2022.
Smile, California launched a promotion in April to support the required Kindergarten Oral Health Assessment (KOHA). The promotion brought awareness to the California law that requires all children to complete a dental assessment by their first year in public school, either Kindergarten or first grade, before May 31. Local oral health programs, school-based health centers, and CBOs received digital toolkits with educational KOHA materials, and the KOHA landing page was updated on SmileCalifornia.org and SonrieCalifornia.org.
In May, Smile, California launched an effort to promote the new Medi-Cal Older Adult Expansion to inform adults 50 years of age or older enrolled in restricted scope Medi-Cal that they are now eligible to receive full-scope Medi-Cal benefits, regardless of immigration status. A new landing page was created on SmileCalifornia.org and SonrieCalifornia.org with information about the expansion, frequently asked questions, and covered dental services. Social media ads and boosted posts ran on the Smile, California Facebook and Instagram accounts throughout May.
At the end of April, SmileCalifornia.org and SonrieCalifornia.org had received 66,794 new visitors, of which 51,361 clicked the “Find a Dentist" button.
