Major Programs and Responsibilities

1. Medi-Cal Program

   • Eligibility determination
   • Benefits administration
   • Provider enrollment
   • Claims processing

2. Behavioral Health

   • Mental health services
   • Substance use disorder treatment
   • Prevention programs
   • Crisis intervention

3. Long-Term Care

   • Nursing facility services
   • Home and community care
   • Assisted living
   • Support services

4. Children's Services

   • California Children's Services
   • Child Health and Disability Prevention
   • Early and Periodic Screening
   • Diagnostic and Treatment

Administrative Structure

The Department operates through several key divisions:

1. Health Care Benefits and Eligibility
2. Health Care Delivery Systems
3. Behavioral Health
4. Enterprise Innovation and Technology
5. Administrative Services
6. Legal Services
7. Legislative and Governmental Affairs

Major Initiatives and Programs

1. Health Care Access

   • Coverage expansion
   • Provider network development
   • Care coordination
   • Quality improvement

2. Payment Systems

   • Fee-for-service
   • Managed care
   • Value-based payments
   • Provider reimbursement

3. Quality Management

   • Performance monitoring
   • Compliance oversight
   • Auditing programs
   • Fraud prevention

4. Information Technology

   • Systems modernization
   • Data management
   • Electronic health records
   • Telehealth services

Program Implementation

1. Service Delivery

   • Provider networks
   • Care management
   • Benefit coordination
   • Access monitoring

2. Program Oversight

   • Quality assurance
   • Utilization review
   • Contract management
   • Performance evaluation

3. Stakeholder Engagement

   • Provider relations
   • Beneficiary services
   • Community outreach
   • Partner collaboration

Performance Metrics

1. Access to Care

   • Provider participation
   • Service availability
   • Appointment wait times
   • Geographic distribution

2. Quality of Care

   • Health outcomes
   • Patient satisfaction
   • Clinical measures
   • Care coordination

3. Program Efficiency

   • Cost management
   • Administrative efficiency
   • Claims processing
   • Error rates

Current Priorities

1. System Modernization

   • Technology updates
   • Process improvement
   • Data integration
   • Digital transformation

2. Health Equity

   • Access disparities
   • Cultural competency
   • Language access
   • Community engagement

3. Care Innovation

   • Payment reform
   • Delivery system transformation
   • Population health
   • Preventive care

Special Programs

1. Dental Services

   • Preventive care
   • Treatment services
   • Specialty care
   • Provider network

2. Pharmacy Benefits

   • Drug coverage
   • Utilization management
   • Rebate programs
   • Clinical guidelines

3. Population Health

   • Health promotion
   • Disease management
   • Care coordination
   • Wellness programs

Sources