Legislative record

Medi-Cal: enhanced care management and community supports.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions. Existing law, subject to implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, requires the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans. Under existing law, target populations include, among others, high utilizers with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits, and individuals experiencing homelessness. This bill would recast the definition of ECM, referring to community-based, high-touch coordination and comprehensive care management services, as specified. The bill would delete certain provisions that designate 2022 or 2023 timelines for commencing ECM coverage, depending on whether or not a Medi-Cal managed care plan operates in a county in which the Whole Person Care pilot program or the Health Home Program was implemented. Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to elect to cover community supports. Under existing law, community supports that the department is authorized to approve include, among others, housing transition navigation services and medically supportive food and nutrition services. This bill would require the department to publish and maintain policy guides and all-plan letters on its internet website that define model coverage standards and policy for each community support, to engage stakeholders, to provide ongoing technical assistance, and to establish a standard timeline and process for regular updates to community supports policy guides, as specified. The bill would require a Medi-Cal managed care plan to adopt community supports policies, and to educate its in-network community support providers, as specified. The bill would require the department to publish certain information on ECM and community supports utilization data on the department's internet website on a quarterly basis, to the extent feasible, until January 1, 2032. The bill would require the department, by March 31, 2029, to provide to the legislative committees specified information in writing necessary to inform legislative consideration of transitioning community supports to benefits that are required to be covered under the Medi-Cal program. The bill would make other technical changes to the ECM and community support provisions.