Latest, page 3
- Published Oct 20
Justice in Aging Outlines State Options to Limit Estate Recovery Harm
In a Justice in Aging publication, the advocacy organization lays out strategies states can adopt to reduce the harms of Medicaid estate recovery on low-income older adults and their families. The piece examines how mandatory recovery of long-term care costs from deceased beneficiaries' estates can strip families of homes and intergenerational wealth, disproportionately affecting low-income and communities of color. It highlights state-level options such as expanding hardship waivers, narrowing the scope of recoverable costs, and limiting liens, within the flexibility states already have under federal estate recovery requirements. The resource is aimed at state policymakers and advocates considering changes to their estate recovery programs.
Why it mattersState Medicaid agencies retain significant discretion over how aggressively they pursue estate recovery, and policy choices here directly affect low-income beneficiaries' housing stability and family wealth.
- Published Oct 20
- Published Oct 20
- Published Oct 19
- Published Oct 19
Retired Surgeon Argues Medicare and Medi-Cal Are "Welfare Fraud"
In a personal opinion essay, a retired Sacramento surgeon argues that Medicare is a disguised welfare program and that Medi-Cal constitutes "bureaucratic welfare fraud," tying his critique to Xavier Becerra's gubernatorial campaign and his "Medicare for All" rhetoric. The author recounts his history with the Tea Party movement during the Affordable Care Act debate, claims disability determinations by California physicians fraudulently funnel people into Medi-Cal, and cites an uncredentialed 2012 flyer titled "American Medical Care Is Terminal" as supporting evidence. The piece contains no new policy development, data, or reported event; it is an ideological commentary on Medicare, Medicaid and government health spending ahead of the November 2026 California election.
Why it mattersFor Medicaid policy professionals, the piece carries no operational or compliance content and serves only as an illustration of politically charged rhetoric around Medi-Cal and disability eligibility circulating in California's gubernatorial race.
- Published Oct 18
California Enacts 2026-27 Budget With Medi-Cal Spending Package
California's enacted 2026-27 spending plan sets funding levels for the state's health programs, including Medi-Cal, State Hospitals, Public Health, Health Care Access and Information, the Health and Human Services Agency, and Covered California. The budget package includes specific spending actions and budget solutions affecting these programs, detailed in appendix tables accompanying this summary. State Medicaid agency staff, providers, and health plans operating in California will be affected by the funding and policy decisions embedded in the plan for the fiscal year. The post is part of an ongoing series summarizing California's annual spending plan by policy area.
Why it mattersState Medicaid agency staff, Medi-Cal managed care plans, and providers need to understand the enacted budget's funding and policy choices to plan for the 2026-27 fiscal year.
- Published Oct 16
California Auditor Finds Department Skipped 26,000 Fraud Probes
California's state auditor, Grant Parks, released a report finding the Department of Health Care Services has failed to investigate 26,000 of the 28,000 Medi-Cal providers flagged as highest-risk for fraud, waste and abuse. The report cites examples including two ineligible providers that billed nearly $1.6 million in 2024-25 and a transportation provider that claimed implausible mileage while collecting over $11 million in the same period. The Department disputes the findings, saying the report omits context and relies on isolated anecdotes rather than system-wide data showing effective controls. The report renews scrutiny of oversight at an agency serving about 14 million Medi-Cal beneficiaries and paying out $200 billion annually, and it was first flagged as high-risk by the state in 2007.
Why it mattersThe findings signal heightened program-integrity scrutiny that could trigger new provider screening requirements, audits, or legislative oversight affecting Medi-Cal providers and managed care plans statewide.
- Published Oct 16
- Published Oct 16
- Published Oct 15
CANHR Explains California's Standard Nursing Home Admission Agreement
In this consumer guide, CANHR explains California's mandatory Standard Admission Agreement (CDPH 327), which all nursing homes in the state must use under a 1997 law barring facility-written contracts. The guide walks residents and families through the agreement's attachments, including separate sections covering Medi-Cal and Medicare coverage of supplies and services, and the Resident Bill of Rights. It stresses that only the resident, or their representative if the resident cannot sign, must sign the agreement, and that representatives are not personally liable for facility bills even if they co-sign. CANHR urges residents to read the actual document presented at admission rather than rely solely on the posted standard version, since facilities need written state approval to alter its terms.
Why it mattersNursing homes and discharge planners must ensure admission paperwork matches the state-approved standard agreement and does not improperly shift financial liability onto residents' family members or representatives.
- Published Oct 15
- Published Oct 14
HPSJ Updates Medi-Cal Medical Benefit Prior Authorization Rules
Health Plan of San Joaquin/Mountain Valley Health Plan's Pharmacy and Therapeutics Committee approved medical benefit changes for Medi-Cal managed care members, effective December 21, 2026. The update removes prior authorization for Aponvie (replacing an obsolete billing code) while adding new PA requirements and strict clinical criteria for Papzimeos, a recurrent respiratory papillomatosis treatment, and Exdensur, a new severe eosinophilic asthma biologic. The plan also tightened inhaled corticosteroid dosing criteria across existing severe asthma biologics, including Nucala, Fasenra, Cinqair, and Tezspire, requiring prescription by an allergist or pulmonologist and documented treatment failures before approval.
Why it mattersProviders billing these J-codes for Medi-Cal managed care members must meet the new documentation and specialist-prescribing requirements or face claim denials starting December 21, 2026.
- Published Oct 14
California Hosts Webinar on Funding Peer Support Workforce
California Health & Human Services announced a webinar providing guidance on sustainable funding for peer support programs. Topics include Medi-Cal billing and certification, Behavioral Health Services Act (BHSA) funding, opioid settlement funds, and other reimbursement pathways. Experts will cover existing funding streams and how providers can achieve Medi-Cal certification and braid multiple funding sources to sustain peer workforce programs. The session targets behavioral health providers and organizations seeking to build long-term funding models for peer support services.
Why it mattersBehavioral health providers and peer support organizations need to understand Medi-Cal certification and braided funding options to keep peer workforce programs financially viable.
- Published Oct 14
Capitol Weekly Op-Ed Urges Expanding California Behavioral Health Access
In a Capitol Weekly commentary, the author argues that California urgently needs to widen access to behavioral health services, posing the central question of where people can turn for help today. The piece contends current pathways to care are too narrow or hard to navigate, leaving many without timely support. While the article does not detail a specific new policy, rule, or funding mechanism, it frames the issue as a systemic gap affecting people who rely on publicly funded behavioral health services, including Medicaid beneficiaries in California.
Why it mattersFor California Medicaid stakeholders, continued advocacy pressure on behavioral health access could shape future state budget priorities and Medi-Cal behavioral health policy debates.
- Published Oct 14
- Published Oct 12
- Published Oct 9
- Published Oct 9
Newsom Opposes California Ballot Measure Prop 44 on Clinic Funding
Governor Gavin Newsom announced opposition to California's Proposition 44, a ballot measure he says would strip health care access for millions of patients by forcing community health clinics to cut services or close. The California Primary Care Association, which leads a coalition of over 300 organizations and 1,000 clinics opposing the measure, welcomed Newsom's endorsement of the "No on Prop 44" campaign. Community health clinics serve roughly 7 million California patients, including about one in three Medi-Cal enrollees, children, seniors, veterans, and uninsured residents, and are often the only care source in rural and underserved areas. The measure will appear before voters on an upcoming Election Day.
Why it mattersIf Prop 44 passes and clinics close or cut services, California's Medi-Cal managed care plans and state agencies would face reduced safety-net capacity for roughly a third of their enrollees in underserved and rural areas.
- Published Oct 9
- Published Oct 8
California Plan Merges GEMT Supplemental Pay Into Standard Claim Checks
Health Plan of San Joaquin/Mountain Valley Health Plan notified providers that, effective October 1, 2026, Ground Emergency Medical Transportation (GEMT) supplemental payments to non-contracted providers will be folded into the standard Medi-Cal fee-for-service check-run rather than issued as a separate check. The change applies to non-contracted GEMT providers eligible for the supplemental payment under DHCS All Plan Letter 20-002 and Assembly Bill 1705. Providers meeting eligibility criteria will now see the GEMT supplement combined with their overall claim payment in one disbursement. The plan directs questions to its Provider Services Representatives or customer service line.
Why it mattersNon-contracted GEMT providers in HPSJ/MVHP's Medi-Cal network need to update payment reconciliation processes since supplemental funds will no longer arrive as a separately identifiable check.
- Published Oct 8
- Published Oct 8
- Published Oct 8
- Published Oct 6
California's Prop. 40 Billionaire Tax Would Backfill Medi-Cal Cuts
California's Proposition 40, on the November ballot, would impose a one-time 5 percent wealth tax on billionaires to help backfill federal cuts to Medi-Cal. The measure splits the Democratic Party: Gov. Gavin Newsom, gubernatorial nominee Xavier Becerra, and major labor unions oppose it, while the state Democratic Party, Bernie Sanders, and Rep. Ro Khanna back it. Early voting is underway, and the measure currently leads 52 percent to 46 percent among likely voters in a PPIC poll. The state's nonpartisan Legislative Analyst's Office projects the tax could raise tens of billions over several years but warns it may also shrink ongoing income tax revenue if billionaires relocate, raising sustainability questions for funding an ongoing program like Medi-Cal.
Why it mattersA one-time wealth tax proposed to offset federal Medicaid funding cuts raises direct questions for California's Medicaid agency and managed care plans about the durability and predictability of state financing for Medi-Cal.
- Published Oct 6
CenCal Health Tells Hospitals to Adopt Updated Medicare MOON Form
CenCal Health notified its CareConnect hospital partners that the Office of Management and Budget has approved a revised Medicare Outpatient Observation Notice (MOON), with updated readability and design and available in English and Spanish. The revised notice is effective immediately and valid through February 28, 2029. Hospitals may exhaust existing stock of the prior version but must fully transition to the updated MOON by April 20, 2026. The notice requirement applies to all Medicare beneficiaries, including health plan enrollees, receiving outpatient observation services, informing them they have not been admitted as inpatients.
Why it mattersHospitals and health plan partners must update forms and workflows by the April 2026 deadline or risk noncompliance with federal beneficiary notice requirements.
- Published Oct 6
CenCal Health Compiles Immigration Know-Your-Rights Resources for Members
CenCal Health, the Medi-Cal managed care plan serving Santa Barbara and San Luis Obispo counties, published a resource roundup directing providers and patients to immigration-related know-your-rights and legal aid materials. The list includes National Immigration Law Center guidance on health care access for immigrants, a California Attorney General reminder of immigrant rights and protections, mental health resources for undocumented people, a factsheet on protecting community spaces from immigration enforcement, and directories for free or low-cost legal assistance. No new CenCal policy or eligibility change is announced; the post simply aggregates existing external resources for use by the plan's network and enrollees.
Why it mattersProviders and care coordinators serving immigrant Medi-Cal populations can use these consolidated resources to help patients understand their rights and maintain access to care without fear of immigration enforcement.
- Published Oct 6
DHCS Updates Guidance on CMS-DHS Medi-Cal Data Sharing, Injunction
California's Department of Health Care Services (DHCS) issued a statement, first released June 13 and updated August 13, addressing reports that CMS shared Medi-Cal member data with the Department of Homeland Security. The update informs members about a federal court injunction that temporarily blocks further data sharing. DHCS and CenCal Health point individuals with unsatisfactory immigration status, or others concerned about their data, to resources including the California Department of Social Services' list of qualified nonprofits, the Immigration and California Families webpage, and local embassy or consulate contacts for legal assistance.
Why it mattersMedi-Cal members and enrollment assister organizations need current guidance on data privacy protections and available legal resources amid ongoing federal litigation over CMS-DHS data sharing.
- Published Oct 6
CenCal Health Opens D-SNP Readiness Grants for Providers
CenCal Health is inviting its contracted CareConnect providers to apply for D-SNP Readiness grant funding ahead of the January 1, 2026 launch of its new HMO Dual Special Needs Plan. Grant funds can be used to enhance staffing, support provider training, and upgrade technology systems needed to serve dual-eligible members. Applications are due by December 1. The program targets providers who will need operational and technical readiness to serve a new dually eligible population under the plan.
Why it mattersContracted providers need to apply by the December 1 deadline to secure funding that builds the staffing and systems capacity required to serve CenCal's new dual-eligible population starting January 2026.
- Published Oct 5
California Medical Groups Split Over Prop 40 Billionaire Tax
California voters will decide in November on Proposition 40, a one-time 5% tax on billionaires' net worth that supporters say could raise up to $100 billion, with 90% directed to a special healthcare fund. The measure would let the Legislature alter the tax with a two-thirds vote as long as changes further its purposes, and it bars using the new money to justify cuts to existing state health appropriations. Despite standing to benefit, groups including the California Medical Association, Planned Parenthood Affiliates of California, the California Primary Care Association and the California Children's Hospital Association oppose it, arguing it lacks clear distribution rules and sufficient safeguards against lawmakers using it to backfill rather than add to health spending. Labor-aligned supporters, including the California Federation of Labor Unions and sponsor SEIU-UHW, say the funding is needed to keep hospitals, emergency rooms and maternity wards staffed as federal funding declines.
Why it mattersState Medicaid-adjacent providers and advocacy groups face major uncertainty over whether a multibillion-dollar funding stream for Medi-Cal and safety-net services will materialize as new money or simply replace existing state commitments.
- Published Oct 5