Family PACT

Required system upgrades to the California Medicaid Management Information System (CA-MMIS) was originally scheduled to take place on August 18, 2024. It will now take place on August 25, 2024. The upgrade will go into an extended maintenance period, which begins at midnight on Sunday, August 25, 2024, and may continue through 6:00 p.m. Sunday, August 25, 2024.

The following Medi-Cal Providers website applications may experience intermittent issues during this window.

• Single and Multiple Subscriber Eligibility
• Share of Cost
• Medical Reservation Services (Medi-Services)
• Lab Service Reservation
• Family Planning, Access, Care, and Treatment (Family PACT)
• Electronic Treatment Authorization Request (eTAR)

Additionally, the following transactions also may experience intermittent issues.

• Automated Eligibility Verification System (AEVS) transactions
• Point of Service (POS) network eligibility transactions from Core Connectivity, Leased Line vendors and Case Management Information and Payrolling System (CMIPS)

Please return to this System Status page for future updates.

If the above link does not take you to the System Status page, then simply copy and paste the following link into your browser.

https://mcweb.apps.prd.cammis.medi-cal.ca.gov/system-status 

Effective July 16, 2024, the Department of Health Care Services has updated the Family Planning, Access, Care, and Treatment (Family PACT) Program’s provider enrollment and responsibilities policy with respect to Site Certifiers role and responsibilities and the Provider Orientation and required trainings for Site Certifiers and practitioners.

Additional information about Provider Enrollment and Responsibilities is available on the Family PACT Provider Enrollment webpage and in the Family PACT Policies, Procedures and Billing Instructions (PPBI) Manual, Provider Enrollment and Responsibilities section.

Effective April 15, 2024, DHCS has expanded the clinicians eligible to be a Family Planning, Access, Care, and Treatment (Family PACT) Program site certifier to include Physician Assistants and has made updates to the required provider training requirements.

Additional information about Provider Enrollment and Responsibilities is available on the Family PACT Provider Enrollment webpage and in the Family PACT Policies, Procedures and Billing Instructions (PPBI) Manual, Provider Enrollment and Responsibilities section. 

Effective for dates of service on or after April 1, 2024, providers are to use the following income guidelines when determining recipient eligibility for the Family PACT Program.

Federal Income Guidelines

200 Percent of Poverty by Family Size

Effective April 1, 2024

The Department of Health Care Services (DHCS) would like to inform pharmacy providers and prescribers about the addition of over-the-counter (OTC) oral contraceptive, Opill® (norgestrel 0.075 mg). This update will be reflected in the April 1, 2024, publication of the Medi-Cal Rx Family PACT Pharmacy Formulary.

Please refer to the Medi-Cal Pharmacy Bulletin for additional information.

Medi-Cal is changing its rules so more people can get covered. Starting January 1, 2024, more adults will be eligible for full Medi-Cal benefits. Immigration status doesn’t matter. Even if you’ve been denied full Medi-Cal recently, you could be eligible now. Learn more about the rule changes and apply today at GetMedi-CalCoverage.dhcs.ca.gov!

The Department of Health Care Services (DHCS) published revisions to the telehealth policy for the Family PACT Program.

The policy has been updated to include:

• Patient Choice of Telehealth Modality; and
• Right to In-Person Services

Providers who offer Family PACT covered benefits and services via telehealth modalities must offer Family PACT clients the choice between telehealth modalities and the ability to opt for in-person services, if desired or clinically appropriate. These options ensure that Family PACT clients can select the most suitable modality for accessing their Family PACT benefits and services based upon individualized preferences, needs and circumstances. For more information, please review the Family PACT Program’s Policies, Procedures and Billing Instructions (PPBI) manual, Benefits: Clinical Services Overview section.

The Family PACT client eligibility and enrollment transaction services will transition from the Health Access Programs Client Eligibility System to the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS), Family PACT portal in early 2025. Updates regarding the implementation of CalHEERS Family PACT portal will be published in future bulletins.

The Office of Family Planning would like to remind providers that per California Welfare and Institutions Code (W&I Code) section 24005, subdivision (i)(3): “The department shall deactivate,… the provider numbers used by a provider to obtain reimbursement from the program when… a provider has not submitted a claim for reimbursement from the program for one year…” Beginning in September, letters will be mailed to providers who did not submit a claim for reimbursement from the Program from January 1, 2022 through July 1, 2023, to notify them of their impending deactivation from the Family PACT Program for non-billing. Providers receiving these letters will have 30 days to respond prior to being deactivated from the Family PACT Program.

DHCS anticipates that proposed Family PACT regulations will be on the rulemaking calendar for 2025. For more information on the DHCS rulemaking process, please visit the DHCS’ Office of Regulations webpage.

On June 8, DHCS submitted a new demonstration project under Section 1115 of the Social Security Act, entitled California’s Reproductive Health Access Demonstration (CalRHAD), to the Centers for Medicare & Medicaid Services. This demonstration will play a key role in advancing California’s progress in providing access to comprehensive sexual and reproductive health services for individuals enrolled in Medi-Cal and other individuals who need access to quality, affordable care.

Visit DHCS CalRHAD Webpage for more information.

Implementing the Next Steps for the End of the Continuous Coverage Requirement

The COVID-19 public health emergency ended, and about 15 million Medi-Cal members will need to renew their Medi-Cal during the next year. DHCS’ top goal is to minimize Medi-Cal member burden and support continuity of coverage and access to equitable, coordinated care.

How You as a Community Member Can Help

1.  Sign up and Become a DHCS Coverage AmbassadorAS a DHCS coverage Ambassador, you and/or your organization are committing outreach to Medi-Cal members in culturally and linguistically appropriate ways. DHCS will provide resources to help connect Medi-Cal members in your community with targeted and impactful information. You will be empowered to:
   • Educate: Raise awareness of actions Medi-Cal members need to take, and when they need to take them to maintain coverage.
   • Engage: Provide community partners with the necessary tools/resources for reaching members. When requested, provide feedback on outreach materials and Medi-Cal member notifications.
   • Provide Consistency: Create a consistent voice across community partners, one message that alleviates confusion among Medi-Cal members.
2. Raise Awareness and Keep Your Community CoveredIf you cannot commit to being a DHCS Coverage Ambassador, you can still use and share the resources we have created to inform Medi-Cal members about the eligibility renewal process.

For more information, visit DHCS website.