$6 Billion Waiver Gets Federal Approval

CMS officials on Saturday agreed in principle to a five-year, $6.2 billion waiver for California’s Medicaid program.

That was good news for California health officials, who plan to use the money mainly for Medi-Cal delivery system and payment reforms — the next big steps in implementing the Affordable Care Act. The state also will get money for its whole-person pilot project and a revamp of its Medi-Cal dental system.

As state and federal officials work out some of the remaining details of the new waiver called “Medi-Cal 2020,” CMS granted the state a temporary extension of the current waiver to Dec. 31. It was due to expire Oct. 31.

“This is a critical step in the waiver renewal process and we appreciate all of the hard work done thus far with CMS. However, much work remains as we develop the details of the waiver programs and components,” said Mari Cantwell, chief deputy director of Health Care Programs and state Medicaid director at the Department of Health Care Services, in a written statement,

The waiver agreement is significantly lower than the state’s original request for $17 billion in programmatic funding.

It’s also about $1 billion lower than the state’s recently revised waiver request that totaled about $7.25 billion.

Some of the “Medi-Cal 2020” waiver details:

  • The grand total for new 1115 waiver funding is set at $6.218 billion over five years, with the potential for additional federal funding for its uninsured effort, which could be determined after the first year, DHCS officials said;
  • The bulk of the waiver, about $3.3 billion, will go toward a public hospital incentive program, to include hospitals operated by municipalities and health care districts. That money is slightly down from the $4 billion requested by DHCS;
  • The state had asked for $1 billion over five years to care for the Global Payment Program, to help handle the remaining uninsured in California. It will get $236 million in the first year of the waiver, with the possibility for more funding later;
  • $750 million will go toward improving dental health programs; and
  • $1.5 billion goes toward the state’s whole-person care pilot.

Erica Murray is president and CEO of the California Association of Public Hospitals and Health Systems. She said this waiver takes big steps toward improving the state’s safety-net system.

“This agreement demonstrates public health care systems’ shared commitment with CMS and the state to improve care and achieve better health for millions of low-income Medi-Cal and uninsured patients in California,” Murray said in a written statement. “Public health care systems are eager to continue negotiating the specifics of the waiver so that we can start working toward achieving these ambitious goals.”

“If the details are worked out and public hospitals, the state and counties take advantage of the opportunities provided, this waiver agreement will help improve care for millions of Californians with Medi-Cal coverage and those who remain uninsured,” said Anthony Wright, executive director of Health Access California, in a written statement.

“Community groups have been working with their counties on revamping and improving their safety-net systems, and this will take those efforts to the next level,” Wright said. “We expect to see an explosion of exciting activity at the county level to improve health care once the details are hammered out.”

Related Topics

Capitol Desk Medi-Cal