Medi-Cal’s Landmark Transformation in California to Improve and Expand Services Gets Federal Approval – State of Reform

The California Department of Health Care Services (DHCS) announced today that it has the green light to launch its long-term commitment to transform and strengthen Medi-Cal. The federal Centers for Medicare & Medicaid Services (CMS) have approved the California Advancing and Innovating Medi-Cal (CalAIM) proposal which will launch on January 1, 2022 and will make Medi-Cal more equitable, coordinated and person-centered to help people maximize their health and their life trajectory.

“We’re making Medi-Cal, which provides health care to one-third of all Californians, the most comprehensive and robust program of its kind in the country. .

Medi-Cal covers one in three Californians, more than half of school-aged children, half of the state’s births, and more than two in three patient days in long-term care facilities. CalAIM’s bold transformation includes multiple federal approvals and aligns all elements of Medi-Cal into a standardized, streamlined, and focused system that helps registrants live healthier lives.

The approvals build on successful pilots to expand innovations statewide, align how care is delivered across delivery systems, and enable California to start the implementation of CalAIM.

“CalAIM reflects California’s commitment to a healthier, fairer state and will be a transformative model for the entire healthcare system,” said the secretary of the California Agency for Health Services and from social services, Dr Mark Ghaly. CalAIM is shifting Medi-Cal to a population health approach that prioritizes prevention and addresses the social factors of health to better serve communities, many of which have historically been underfunded and faced with structural racism in health care. “

CMS has approved new statewide Medi-Cal services that will help people stay out of hospital and live in the community, as well as certain waivers to implement program changes that go beyond. beyond what can be accomplished under state Medicaid options. They include:

Improved care management addresses the clinical and non-clinical needs of the most needy Medi-Cal registrants through intensive coordination of health and health-related services. He will meet with registrants primarily through face-to-face engagement where they live, seek care and choose to access services – on the street, in a shelter, in their doctor’s office, or at home.

Community support provides new statewide services covered by Medi-Cal managed care plans as medically appropriate alternatives to traditional medical services or settings, including housing assistance, caregiver respite, l ‘food insecurity and the transition from nursing home care to the community.

Providing Health Access and Transformation (PATH) supports provides funding to community organizations, counties and other local providers to support capacity building as they begin to implement and scale up improved care management and community supports, particularly by increasing resources available to populations and communities that have historically been underfunded and underfunded. -served. In addition, PATH will support adults and youth involved in the justice system by supporting pre-release and post-release services.

Transformation and alignment of the delivery system moves California’s managed care delivery systems – Medi-Cal Managed Care, Dental Managed Care, Specialty Mental Health Services, and Drug Medi-Cal Organized Delivery System – to a single coordinating authority to simplify and align programs, improve monitoring and standardizing the benefits and registration with Medi-Cal. The waiver reinforces the state’s commitment to ensure that registrants have access to essential managed care services through independent assessments of access to specialized mental health services, to the organized drug distribution system Medi- Cal and managed dental care and services, as well as independent assessment. compare the adequacy of the Medi-Cal managed care plan network across the Medi-Cal managed care, Medicare Advantage and the private market.

Services and initiatives for substance use disorders advances the treatment of people with substance use disorders, including evidence-based contingency management to reduce stimulant use, peer support specialists to promote recovery and prevent relapses, and short-term residential treatment if necessary to advance treatment of enrollees. California’s approval of the state’s emergency management pilot project marks the first time it has been officially approved as a benefit in the Medicaid program.

New dental benefits extends key dental benefits statewide, including a tool to identify risk factors for tooth decay for all children Medi-Cal, and silver diamine fluoride for children and select populations at high risk. Statewide pay-for-performance initiatives will reward dental providers for their focus on preventative services and continuity of care.

Support coordination and integration for dual eligibilities better coordinate coverage programs for the complex health care needs of people eligible for both Medi-Cal and Medicare (“Double Eligible”). CalAIM provides a special type of managed care plan that coordinates all benefits into one plan for eligible registrants, creating an infrastructure to integrate long-term managed services and supports for all qualifying Medi-Cal registrants.

Global Payments Program renews the California statewide funding pool for care provided to California’s remaining uninsured populations. This includes streamlining funding sources for the uninsured California population served by public hospitals, with a focus on meeting social needs and responding to the impacts of systemic racism and inequality.

Chiropractic Services for Indian Health Services and Tribal Settlements retains the authority to pay tribal providers for these services, which were phased out of benefits covered by Medi-Cal in 2009.

California is excited to begin the statewide implementation of CalAIM to provide Medi-Cal registrants with consistent access to the care they need, when they need it, regardless of zip code. or the language they speak, ”said Michelle Baass, director of DHCS. “The CalAIM transition requires sustained focus and commitment, but when completed it will fundamentally improve the lives of millions of Californians. We have a long way to go, but it’s the right path and a journey we need to take to help care for people across our Golden State. “

Additional CalAIM approvals expected in 2022

DHCS and CMS continue to work towards obtaining additional approvals for equity-focused CalAIM initiatives that provide services and supports to adults and youth involved in justice, and reimbursement for traditional healers and caregivers. caregivers. The justice initiative involved will focus on stabilizing the health of populations affected by justice prior to release, ensuring continuity of coverage through enrollment strategies prior to Medi-Cal’s release, and supporting return in the community. Traditional healers and caregivers provide culturally appropriate options and improved access to substance abuse treatment for Native Americans and Alaska Natives who receive services through Indian health care providers. CMS approval of these waivers is expected in early 2022.

“Through CalAIM, California is redefining access to care, extending beyond traditional hospitals and settings to communities, meeting people where they are and providing culturally appropriate care and support to improve health outcomes, ”concluded Jacey Cooper, state director of Medicaid. “CMS approval kicks off the transition to better person-centered care for those who need it most. “

This press release was provided by the California Department of Health Care Services (DHCS).

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