News and Updates Archive
Update: Systems Upgrades Scheduled for August 2024
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
Family PACT Provider Enrollment and Responsibilities Policy Updated
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.
Family PACT Provider Enrollment and Responsibilities Policy Updated
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.
Family PACT Program Update: 2024 Income Eligibility Guidelines
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.h
Federal Income Guidelines
200 Percent of Poverty by Family Size
Effective April 1, 2024
| Number of Persons in Family/Household | Monthly Income | Annual Income |
| 1 | $2,510 | $30,120 |
| 2 | $3,407 | $40,880 |
| 3 | $4,303 | $51,640 |
| 4 | $5,200 | $62,400 |
| 5 | $6,097 | $73,160 |
| 6 | $6,993 | $83,920 |
| 7 | $7,890 | $94,680 |
| 8 | $8,787 | $105,440 |
| For each additional member, add: | $897 | $10,760 |
Department of Health Care Services Expands Adult Full Scope Medi-Cal for Qualifying Individuals Ages 26 through 49
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!
Family PACT Telehealth Policy Update
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.
Non-Billing for One Year
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.
California’s Reproductive Health Access Demonstration (CalRHAD)
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.
Termination of COVID-19 Flexibilities for Family PACT and Updated Client Enrollment Policy (May 2023)
On March 26, 2020, DHCS published guidance that allowed Family PACT providers to enroll and recertify clients through telehealth or other virtual/telephonic communication modalities during the federally-declared COVID-19 Public Health Emergency (PHE). As noted in the guidance, the temporary flexibilities related to client enrollment and recertification would end upon termination of the PHE. The U.S. Department of Health and Human Services has announced its intention to end the COVID-19 PHE on May 11, 2023.
In preparation for the end of the COVID-19 PHE, DHCS updated the client enrollment policy to allow Family PACT providers to continue to enroll and recertify clients through synchronous or telephonic modalities post PHE, and solicited public comment on the draft policy. DHCS’ responses to comments received can be found in the link below.
Effective for dates of service on or after May 12, 2023, Family PACT providers must adhere to the updated Client Eligibility section published in the Family PACT Policies, Procedures and Billing Instructions (PPBI) manual. Final Policy DHCS Responses to Public Comments
State Seeks Coverage Ambassadors to Reach Medi-Cal Beneficiaries (December 2022)
California is launching a statewide effort to help Medi-Cal beneficiaries keep their Medi-Cal coverage or be enrolled in other coverage.
During the national public health emergency (PHE), the annual reevaluation of ongoing eligibility was temporarily paused to ensure vulnerable Californians had ongoing access to health coverage. When the PHE ends, the state will resume normal Medi-Cal eligibility operations and the annual eligibility review. As a result of that process, two to three million beneficiaries could no longer be eligible for Medi-Cal. The state, along with its partners, are engaging in a comprehensive campaign to reach beneficiaries with information about what to expect and what they need to do to keep their health coverage.
DHCS has launched a customizable Medi-Cal Continuous Coverage toolkit and webpage to help trusted entities and individuals act as DHCS Coverage Ambassadors to push communications to Medi-Cal beneficiaries to encourage them to update their contact information with their counties to ensure they receive important information about keeping their Medi-Cal coverage.
Our primary goals through the DHCS Coverage Ambassador campaign are to help our beneficiaries keep their current Medi-Cal coverage, get free or low-cost coverage from Covered California or other government programs, or transition to their employer-sponsored health coverage.
The eligibility redeterminations will be conducted by counties based upon a beneficiary’s next annual renewal date (done on a rolling basis and not all at once). Before the PHE, California would review information provided by beneficiaries annually and renew their coverage if they still qualified. When the COVID-19 continuous coverage requirement expires at the end of the PHE, California will need to conduct a full redetermination for all beneficiaries. States will have up to 12 months, plus two additional months due to renewal processing policies, to return to normal eligibility and enrollment operations, which includes conducting a full renewal for all individuals enrolled in Medi-Cal and CHIP.
DHCS will shift the focus of the campaign 60 days prior to the end of the COVID-19 PHE and will encourage beneficiaries to report any changes in their personal circumstances, and check their mail for upcoming renewal packets, should the county be unable to complete the renewal using information already available to them without having to contact the beneficiary.
Updated toolkits will be posted on the DHCS website and be distributed to people who signed up to serve as DHCS Coverage Ambassadors. DHCS encourages everyone to join the mailing list to receive the latest information and updated toolkits.
As additional toolkits or resources become available, DHCS will also email critical updates to keep DHCS Coverage Ambassadors informed so they can spread the word to their community.
Select Comprehensive Family Planning Services Policy Update (December 29, 2017)
The Family PACT Program will provide time-limited supplemental payments to Family PACT providers for Evaluation and Management (E&M) office visits rendered for comprehensive family planning services for the period of July 1, 2018 through June 30, 2019. These supplemental payments are equal to 150% of the reimbursement amount for procedure codes 99201, 99202, 99203, 99204, 99211, 99212, 99213, and 99214.
ACA’s Nondiscrimination Policy Applies to Family PACT (August 8, 2017)
Section 1557 of the Patient Protection and Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs or activities. In effect since 2010, Section 1557 builds on long-standing federal civil rights laws: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975.
Effective July 18, 2016, the Health and Human Services (HHS) Office for Civil Rights issued its final rule implementing Section 1557 at Title 45 Code of Federal Regulations (CFR) Part 92. The rule applies to any health program or activity, any part of which receives federal financial assistance, an entity established under Title I of the ACA that administers a health program or activity, and HHS. In addition to other requirements, Title 45 CFR Part 92.201, requires:
- Language assistance services requirements. Language assistance services required under paragraph (a) of Part 92.201 must be accurate, timely and provided free of charge, and protect the privacy and independence of the individual with limited English proficiency.
- Specific requirements for interpreter and translation services. Subject to paragraph (a) of Part 92.201:
- A covered entity shall offer a qualified interpreter to an individual with limited English proficiency when oral interpretation is a reasonable step to provide meaningful access for that individual with limited English proficiency.
- A covered entity shall use a qualified translator when translating written content in paper or electronic form.
For more information about the application and requirements of the final rule implementing Section 1557, providers should contact their representative professional organizations. They may also visit Section 1557 of the Patient Protection and Affordable Care Act page of the HHS website to find sample materials and other resources.