Medicaid State Plan Amendments

The state is amending the Community First Choice (CFC) program to add six years of professional/practical social service experience performing functions equivalent to a Social Service Specialist 2 as a qualification for individuals performing evaluations/assessments for CFC services.

This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding pharmacies as supervisors for Community Health Workers. This SPA also updates the ABP to add peer support services, Drug Medi-Cal Organized Delivery Systems SUD treatment, and mobile crisis teams.

This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by allowing FQHCs and RHCs to bill for encounters by licensed professional clinical counselors and associate professional clinical counselors.

This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding doula services and updates the Federally Qualified Health Centers (FQHC) and Rural Health Clinic (RHC) services category to include associate marriage and family therapist (AMFT) services and associate clinical social worker (ACSW) services.

This amendment proposes to align the Alternative Benefit Plan with the Medicaid state plan by adding asthma prevention services, community health worker services, and coverage of routine patient costs in clinical trials.

This amendment proposes to extend the Recovery Audit Contractor exception for an additional two years through June 30, 2026.

This amendment is to update State Plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.

This amendment adds enhanced mobile crisis services to the Medicaid state plan.

This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by allowing physician assistants, nurse practitioners, and clinical nurse specialists, in addition to physicians, to order home health services, including durable medical equipment and medical supplies.

This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding Medication Therapy Management (MTM) under Pharmacist Services.