State health officials this week will start the lengthy process to renew California’s federal 1115 Medicaid waiver — the state’s five-year health care reform project. The “Bridge to Reform” included many of the state’s delivery and payment reforms in recent years, including the expansion of Medi-Cal to include Californians up to 133% of federal poverty level.

The waiver is due to expire in October 2015. The state wants to have its new waiver application done early next year.

The next waiver application will include new reforms, including a number of ideas of shared-savings programs. On Friday, officials from the Department of Health Care Services will open the discussion about those new reforms during a stakeholder webinar. 

DHCS officials floated seven shared-savings ideas for discussion in an introductory paper.

According to the DHCS concept document: “A critical component to the success of the Affordable Care Act will be the ability for states to slow the cost growth of the Medicaid program while also ensuring access to high-quality health care,” the paper said.

“Absent flexibilities and innovations California is seeking under this 2015 waiver, we expect that costs would not only continue to grow but would grow at an increasing trend, in part due to the significant expansion of coverage in both Medicaid and through the health insurance exchange that puts significant pressure on access and provider rates,” the paper said. “Under a new Medicaid Waiver, California would seek federal support to promote cost efficiency and access through a shared savings initiative.”

Ideas outlined in the state paper include:

• California could establish annual payments for Medi- Cal beneficiaries covered under the waiver;
• Payment and delivery reform programs that would include patient-centered medical homes;
• Safety net payment reforms to align incentives for safety net providers to better coordinate care for uninsured populations;
• Payment and delivery reform of federally qualified health centers;
• A successor program to the state’s Delivery System Reform Incentive Payment program for public hospitals and clinics;
• Changes to the California Children’s Services program, such as pay-for-performance incentives; and
• Workforce development possibilities, such as subsidies for malpractice insurance premiums for physicians willing to devote a certain portion of their practice to Medi-Cal patients.

The concept paper said: “This shared-savings initiative would provide California with the incentive to slow the growth of cost in the Medicaid program while also enabling the state to use the shared savings to invest in our delivery system to help ensure access and quality for California’s Medicaid beneficiaries.”