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DHCS Proposes Significant Changes to Medi-Cal Service Delivery

By Brenda Klüz, Senior Policy Consultant, LeadingAge California

DHCS has released a proposal that makes sweeping changes to the way that Medi-Cal services are delivered – California Advancing and Innovating Medi-Cal initiative (CalAIM). 

A snapshot of what this could mean for LeadingAge California members and communities includes:

  • Moving all SNF, ICF-DD/H, ICF-DDN and pediatric/adult subacute services into Medi-Cal Managed Care Plans (MMCPs) by January 2021.
  • Has a stated goal of reducing skilled nursing care utilization.
  • Displays a marked preference for residential models of care (i.e. RCFEs) and utilization of home and community-based services and provides some care management supports.
  • Builds a process to better support housing options for MMCP members who are homeless, at risk for becoming homeless or with multiple chronic conditions [including serious mental illness and/or serious substance use disorders.
  • Provision for Enhanced Care Management and “in-lieu” of services to better manage care for MMCP members.
  • Authorization of additional hours for personal and homemaker services beyond those approved for IHSS.
  • Authorization for in-home or out-of-home caregiver respite.

What this means for Medi-Cal Managed Care Plans (MMCPs):

  • Expecting MMCPs to better managed member risk and work across health delivery systems to treat the whole person (primary care, LTC, behavioral health, substance use disorders, homelessness, special nutritional needs, etc.)
  • DHCS is proposing to move to regional rates in counties where there are more than one MMCP.
  • MMCP members will have one, annual open enrollment period within which to change plans.

LeadingAge California staff have already initiated strategy sessions to address this complex, far-reaching proposal on behalf of members.  We will be at the table to not only discuss the proposal, but important services that are not mentioned in the proposal, but might also be affected.

Stay tuned for additional information about the proposal and how we can work together to best represent you and your communities.