February 6, 2020

CSAC and Counties continue to engage in the robust stakeholder process for the Governor’s Medi-Cal Healthier California for All initiative, formerly known as CalAIM. The initiative seeks to streamline and simplify the state’s Medicaid program while presenting opportunities for counties to better serve Medi-Cal beneficiaries and special populations such as foster youth, those living without shelter, and people transitioning from institutions like jails, hospitals, and skilled nursing facilities.

At the outset of the Medi-Cal Healthier California for All process last fall, counties expressed strong concerns about the future of Whole Person Care (WPC), the loss of federal funding for our safety net public hospitals, and the potential loss of county Targeted Case Management (TCM) coordination services under the proposal.

Since that time, the Department of Health Care Services (DHCS) has modified components of the initiative to respond to these concerns. While the overarching theme of Medi-Cal Healthier California for All is to imbue the state’s Medi-Cal Managed Care Organizations (MCO’s) with more responsibility for both health and health-related activities, DHCS has indicated that they understand the key role that counties and county public hospitals play in WPC, case management and coordination, and population health management. As of this writing, DHCS is publicly considering a requirement for managed care organizations to work with counties on WPC and has retreated from eliminating TCM activities for counties. However, public hospital funding levels remain yet to be resolved.

The initiative isn’t all about challenges, however, and includes opportunities to expand WPC and the Drug Medi-Cal Organized Delivery System (DMC-ODS) pilots statewide, update the state’s definition of Medical Necessity to allow counties to begin treatment before a clinical diagnosis is applied, paying counties to do “jail in-reach” activities to ensure a smooth transition from jail into the community, improving foster youth access to Medi-Cal services, and developing an innovative and collaborative population health management strategy to benefit the health of all Californians.

The public stakeholder process continues through February, after which DHCS hopes to release a draft of the state’s Medi-Cal Healthier California for All proposal by late spring. Timing is critical since both the state’s 1915b Freedom of Choice and Medi-Cal 2020 Section 1115 Medicaid waivers expire this calendar year. For more information on Medi-Cal Healthier California for All, visit https://www.dhcs.ca.gov/provgovpart/pages/medi-calhealthiercaforall.aspx.