DHCS Stakeholder Updates - July 1, 2022
Dear Stakeholders,
The Department of Health Care Services (DHCS) is providing this update of significant developments regarding DHCS programs.
Awarding of Dental Contract
On July 1, 2022, DHCS issued a Notice of Intent to Award for the Fiscal Intermediary-Dental Business Operations (FI-DBO) contract, which will provide services to support California's Medi-Cal fee-for-service dental benefit. Following a competitive procurement process, the successful bidder is Gainwell Technologies LLC.
Over the next year, the incumbent vendor, Delta Dental of California, will transition operations to the new vendor, Gainwell. The anticipated date for Gainwell to assume responsibility for dental business operations is October 1, 2023. DHCS' goal is for this transition to be seamless for Medi-Cal members and providers, with no reduction in or delay of services.
Proposition 56 Loan Repayment Program – CalHealthCares
DHCS announced its commitment to pay $64.9 million toward student loans for 222 physicians and 35 dentists under CalHealthCares to expand access to care for Medi-Cal patients under a fourth cohort of awardees. Of the 257 awardees, 62 percent are persons of color, and 79 percent speak a language other than English. The physicians represent 67 specialties and serve 33 counties. The dentists represent four specialties and serve 19 counties. The awardees have agreed to maintain a caseload of at least 30 percent Medi-Cal patients, with more than 57 percent of awardees committing to maintaining a caseload of 65 percent or higher. A fifth cohort is scheduled for 2023. For more information, visit the
CalHealthCares website.
Enhanced Care Management (ECM) and Community Supports Benefit Update
Beginning July 1, the ECM benefit is available in all California counties to eligible Medi-Cal managed care plan (MCP) members for the following populations of focus: individuals and families experiencing homelessness, high utilizers, and adults with serious mental illness (SMI) / substance use disorders (SUD). Counties newly implementing ECM as of July 1 include Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Inyo, Lake, Lassen, Madera, Mariposa, Merced, Modoc, Mono, Nevada, Plumas, San Benito, San Luis Obispo, Santa Barbara, Sierra, Siskiyou, Solano, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, and Yuba.
Also, as of July 1, MCPs are implementing an additional 266 Community Supports, expanding service availability for these unique offerings to all 58 California counties. Significant service expansions include the housing-related Community Supports services, with MCPs introducing 35 new housing transition navigation services, 44 new housing deposits, and 36 new housing tenancy and sustaining services, as well as respite services (34 new offerings) and personal care and homemaker services (31 new offerings). With 518 Community Supports already available since initial program implementation on January 1, there are now 784 distinct Community Supports offerings available across all 58 counties in California. DHCS created a publicly available Community Supports map showing the number of the 14 pre-approved Community Supports going live in 2022 by county and implementation date. A Community Supports Election Chart is also available, detailing which are available under each MCP in each county and forecasting future expected service offerings.
Community Health Worker (CHW) Benefit
On July 1, the CHW benefit went live in both the Medi-Cal fee-for-service (FFS) and managed care delivery systems. The State Plan Amendment (SPA) for CHWs was submitted to the Centers for Medicare & Medicaid Services (CMS) on April 29, 2022, and is pending approval. DHCS published the final CHW policy on June 29 to assist providers with rolling out this new benefit. DHCS shared a draft of the Provider Manual pages for CHW services, as well as a new Provider Manual section for asthma preventive services, with stakeholders prior to finalizing them for publication. The Provider Manual pages are scheduled to be published on July 15. In addition, DHCS shared a draft All Plan Letter (APL) for CHW services with its managed care health plan partners on June 28 for comments prior to issuing the APL. Comments on the APL are due by July 12. More information about the Department's development of the CHW benefit, including the pending SPA that was submitted to CMS, is available on CHW webpage.
