A new Medi-Cal waiver being negotiated now between California and CMS is portrayed as a bridge between the existing Medi-Cal program and the full-access expansion envisioned for 2014 in federal health care reform.
The federal government allows states to make changes to their Medicaid programs — Medi-Cal in California — to adjust to specific circumstances. These changes, made through a series of waivers to federal rules, are negotiated between states and CMS. California has several waivers in place, the largest and most significant being the 1115 waiver that has been in effect since 2005 and expires Aug. 31.
For the past five years, California has used its 1115 waiver to wring out millions of extra federal dollars and design efficient ways to use Medicaid money — including managed care Medi-Cal programs, augmented payments for hospitals serving large Medi-Cal populations, and special payments and services for safety-net community clinics serving large numbers of low-income and uninsured people.
The last 1115 waiver was seen as an end unto itself, but this time, the waiver comes in the foreground of profound change that will increase Medi-Cal enrollment by millions in the second half of this decade.
We asked stakeholders how California can best design this bridge to make the most of the next four years, while creating the best environment for health care reform to take root in California.
- What are the most important considerations in creating the new waiver?
- What are the potential pitfalls to be avoided?
- How can the waiver best be used to get California ready for the Medi-Cal expansion?
CMS officials said they could not comment during negotiations. We got responses from: