New proposed regulation from CMS contain many new and updated requirements for states, Medicaid managed care plans, and providers intended to improve beneficiary access to care, quality, and health outcomes in both fee-for-service (FFS) and managed care delivery systems while advancing CMS’ goals.

Californians, like the rest of the country, are facing significant mental health challenges in the aftermath of the pandemic. The need for new and enhanced behavioral health supports and interventions has come into strong focus in recent years and states are leveraging their Medicaid programs to respond.

In November 2022, United States Senators Cassidy, Carper, Scott, Warner, Cornyn, and Menendez issued a request for information (RFI) regarding approaches for improving coverage for individuals who are dually eligible for Medicare and Medicaid. Dual eligible beneficiaries are more likely to have  complex health needs that are difficult and often expensive to treat. Too often, they experience a lack of integration and coordination that often results in confusing encounters with the health care system and negative health outcomes.

In November 2022, United States Senators Cassidy, Carper, Scott, Warner, Cornyn, and Menendez issued a request for information (RFI) regarding approaches for improving coverage for individuals who are dually eligible for Medicare and Medicaid. Dual eligible beneficiaries are more likely to have  complex health needs that are difficult and often expensive to treat. Too often, they experience a lack of integration and coordination that often results in confusing encounters with the health care system and negative health outcomes.

Enhanced Care Management (ECM) and Community Supports are core components of CalAIM, a multiyear initiative led by the California Department of Health Care Services (DHCS) that take a person-centered approach to social service delivery and care management for individuals with complex health and social needs.

A core element of all Medicaid Section 1115 “research and demonstration” waivers is an evaluation of the demonstration program and its efficacy in meeting the demonstration’s goals. Historically, however, Section 1115 waiver evaluations have been an afterthought for states and CMS, limiting their ability to inform future Medicaid policy and financing approaches.

By Lilly Clements, Junior Policy Consultant and Megan Thomas, Associate Director

Since 2014, the Cal MediConnect (CMC) program has coordinated care for some of the most vulnerable Californians. CMC was developed by the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) to better serve dual eligible beneficiaries – those enrolled in both Medicare and Medi-Cal (Medicaid in California).

A primary focus of CMC is to better coordinate behavioral health care service delivery for members. This week, DHCS released a report entitled “Improving Behavioral Health Integration and Coordination for Cal MediConnect (CMC) Members,” which details the complexities and nuances of CMC plans’ efforts to integrate behavioral health into the care delivery system for dual eligible beneficiaries.