State Submits $17B Waiver Plan; Advocates Urge Medi-Cal Rate Review

California health officials submitted a Medicaid waiver request to federal regulators calling for $17 billion in health care reform projects in a five-year proposal.

The 1115 federal waiver proposal seeks to build on the first five-year Medi-Cal “Bridge to Reform waiver” approved in 2010.

In a letter to federal regulators last week, a consortium of advocacy groups — including the California Medical Association — asked CMS for an independent review of the waiver proposal.

“We … respectfully urge CMS to require California to conduct an independent assessment of Medicaid provider reimbursement rates as a condition of approval of the state’s 1115 Medicaid waiver,” the letter said. “We believe an independent assessment of rates is necessary.”

The $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 wants to build on the successful health care reforms from the first waiver with the next one, known as “Medi-Cal 2020.”  

The payment reform and delivery system projects would move California into the next stage of health care reform. Now that Medi-Cal has been expanded to about 12 million Californians, it’s time to refine how care will be delivered to all of those beneficiaries, state officials have said in previous interviews.

Mari Cantwell, chief deputy director at DHCS, said earlier this month that the components of the waiver request have remained relatively intact throughout the stakeholder refinement process.

“What you’ll see in our proposal is consistent with what we’ve discussed before,” Cantwell said. “Nothing is missing, there aren’t any big surprises.”

The letter from the California Medical Association and 17 other provider and advocacy groups throws a wrench into the waiver process. State officials have said they’ve made a special effort to solicit stakeholder input for this waiver renewal. But for 18 significant stakeholders in California, it clearly wasn’t enough.

“The goal of this waiver is to allow California to experiment with innovative ways to improve patient care, as well as reimburse, recruit and retain physicians for the Medi-Cal program,” the letter said. “As such, we urge CMS to make an independent assessment of rates a priority in the renewal of California’s Section 1115 Medicaid waiver.”

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