Federal Government Approves Medicaid Overhaul in California | New policies

By DON THOMPSON, Associated Press

SACRAMENTO, Calif. (AP) – The U.S. government has approved California’s overhaul of the nation’s largest insurance program for low-income and disabled residents, officials said on Wednesday, a move that, among other things, allows the Medicaid money to be spent on housing-related services. as the most populous state grapples with homelessness and a lack of affordable housing.

CalAIM – California Advancing and Innovating Medi-Cal – envisions a more holistic approach that improves “the entire continuum of care” through the program California calls Medi-Cal, according to the California Department of Health Care Services.

Starting on New Years Saturday, California will, among other things, expand what was a “comprehensive human care pilot program” limited to eligible Medi-Cal members statewide.

“We are 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,” Gov. Gavin Newsom said in a statement.

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In addition to covering one in three Californians, Medi-Cal covers more than half of school-aged children, half of births in California and more than two in three patient days in long-term care facilities, said officials.

The aim of the new approach is to prioritize prevention and address the underlying societal conditions, especially in populations who have had fewer health services and who have faced structural racism in communities. health care, said California Health and Human Services Agency secretary Dr. Mark Ghaly.

California’s Medicaid program offers government-funded insurance to people aged 50 and over and 25 and under, regardless of their immigration status. California has the largest Medicaid program in the country.

Medi-Cal benefits will not change. But what are known as “enhanced care management services” can now include a “care coordinator” as part of the care plans managed by Medi-Cal.

The coordinator can help Medi-Cal members find doctors, schedule appointments, and arrange medical transportation. The coordinator can also help members understand their medications, obtain mental health services, and locate and apply for community services such as housing subsidies or food assistance.

“The goal here is to expand supports and services beyond hospitals and health care facilities directly into the communities that need it most,” said Tina Rivera, Acting Director of the Services Department. County of Sonoma Health.

The state transfers four programs – Medi-Cal Managed Care, Dental Managed Care, Specialty Mental Health Services, and Drug Medi-Cal Organized Delivery System – into a single coordinating authority. Officials said this was aimed at simplifying and aligning programs while standardizing benefits and enrollments.

Medicaid services will now for the first time officially include drug treatment, including short-term residential treatment when needed.

The program is also expanding some statewide dental benefits, including efforts to detect risk factors for tooth decay in children and to provide silver diamine fluoride to children and other populations. at high risk.

The state promises, under the new system, to better coordinate programs under a managed care plan for older residents who are eligible for both Medi-Cal and Medicare.

Federal approvals also renew a statewide funding pool for care provided to remaining uninsured California residents, such as those served by public hospitals.

These 21 public health systems only include 6% of California hospitals, but they said they provide 40% of inpatient care for other uninsured and 35% of inpatient care for Medi-Cal beneficiaries.

Erica Murray, president and CEO of the California Association of Public Hospitals and Health Systems, said the funding pool “gives public health systems the flexibility to deliver the right care in the right setting to people who are not. insured “.

The new approvals also reinstate chiropractic service coverage for the Indian Health Service and Tribal Settlements, which was removed in 2009.

California is awaiting approval from the Centers for Medicare & Medicaid Services early next year to expand services to adults and youth involved in the criminal justice system before they are released from custody, so that they continue to receive these services in the community.

Another pending waiver would allow Medi-Cal to reimburse certain traditional healers and natural assistants for Native Americans and Alaska Natives.

Copyright 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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