State Seeks Renewal of Medi-Cal Waiver To Help Expand Health Coverage
Public health officials in California are seeking to renew the state's Section 1115 waiver to secure $10 billion in federal reimbursement for Medi-Cal, California's Medicaid program, the Inland Valley Daily Bulletin reports.
California's current Medi-Cal waiver is scheduled to expire at the end of August. The state's Department of Health Care Services, which manages Medi-Cal, is in negotiations with CMS over the terms of a waiver extension.
Criteria for Waiver
Under Section 1115 of the Social Security Act, HHS can authorize states to pursue projects "intended to demonstrate and evaluate a policy or approach that has not been demonstrated on a widespread basis."Â
According to the National Health Policy Forum, states applying for the waiver extension must demonstrate that activities covered by the waiver are "budget neutral." This means federal spending during the five-year waiver period must be the same as federal spending without the waiver.
DHCS plans to achieve budget neutrality by restructuring some of its Medi-Cal programs and redirecting funds to expand coverage for uninsured residents. In its implementation plan, the department has proposed:
- Expanding the state's 10-county Health Care Coverage Initiative to all counties that elect to participate;
- Phasing in coverage for adults ages 19 to 64 who have annual incomes up to 200% of the federal poverty level and are currently not eligible for Medicaid;
- Creating more coordinated systems of care and strengthening existing managed care plans; and
- Assigning enrollees to a single medical home that would manage patients' medical information and provide preventive and primary health care services.
Possible Changes for Hospitals
California's Medi-Cal waiver plan also calls for changes that could affect hospitals. For example, the state has proposed:
- Using more than $960 million in federal funds annually to ensure that the state's Safety-Net Care Pool can continue supporting safety-net hospitals and other critical programs;
- Reforming public hospital payment systems to better align payment with care delivery incentives; and
- Establishing a Delivery System Investment Pool that would provide funds to hospital systems that develop and implement plans to improve care coordination for vulnerable populations (DiMartino, Inland Valley Daily Bulletin, 8/13).