State ‘A Few Weeks’ From Waiver Draft

The state is weeks away from finishing the first draft of a new 1115 federal Medicaid waiver, according to Jennifer Kent, director of the Department of Health Care Services.

In her first legislative hearing since being appointed director last month, Kent told the Assembly Budget Subcommittee on Health and Human Services about potential gaps and opportunities in the state’s health care system.

One of the big opportunities on the horizon, she said, is renewal of the 1115 waiver. The five-year, $10 billion “Bridge to Reform” waiver helped create the Low Income Health Program and implement the Affordable Care Act. It is due to expire in October and the state plans to submit a new proposal to federal officials that builds from the success of the first waiver.  

“We’re looking at 2015 as kind of the deep breath after we have rushed to get to the finish line of 2014,” Kent said. “Now that we’ve implemented the basic provisions [of the ACA], how do we go about refining our work?”

The first answer will be found in the 1115 waiver proposal, she said.

“This renewal of the waiver, we’re really looking at it as a way to take [the ACA implementation] to a new frontier, if you will,” Kent said. “It’s not enough that you have just have coverage, and that you’re walking around with a Medi-Cal card, but what does that card actually get you? Does it get you your physical medical services, does it get you your mental health services, does it address if you have a substance use problem? People who utilize multiple system issues should not be treated in a silo, because their issues are not siloed.”

The state’s proposed waiver centers on payment reforms, but it’s more than that, Kent said.

“The waiver is testing out new concepts and trying to get new funding and investment for how we break those barriers down,” Kent said. “So the waiver is a phenomenal opportunity for us as a state to demonstrate new and exciting ways, both from a payment perspective … but also [for] the services that we provide to beneficiaries in the right setting.”

The waiver is close to final draft form that can be distributed to stakeholders and the public for discussion, she said.

“We hope to have a draft in the next few weeks,” Kent said.

Kent also mentioned one potentially large gap in the health care budget: the managed care organization tax, which represents about $1 billion in funding to California and which federal officials have said is not viable in its current form.

“That would be a big gap if it’s not appropriately addressed,” Kent said.

She also said monitoring Medi-Cal managed care plans would be critical to addressing the concerns raised by many consumer advocates and stakeholders.

“We are now a managed care state,” Kent said, with all 58 counties served by Medi-Cal managed care plans.

“The question is, are people getting access to care at the right time and the right place, and are there enough providers to care for them?” Kent said. “One of the things we’ll be working on is, how do we monitor our plans to make sure people are getting the right access.”

Current monitoring efforts set a strong foundation for that effort, she said.

“We have a lot of Medi-Cal quality measures we have implemented,” Kent said. “I think what we’re doing today in Medi-Cal managed care, in terms of our quality monitoring, we will probably be a national leader, because no one is doing what we’re doing in terms of quality monitoring.”

Related Topics

Capitol Desk Medi-Cal