Agreement Expected Today on Medicaid Waiver

The formal deadline for wrapping up negotiations on the federal Medicaid waiver for California is Oct. 31, and state officials say it might go right up to the deadline. But since that deadline is on Sunday, health care policy experts are expecting an agreement to be formalized and announced two days earlier than that — by today.

The Medicaid waiver is a complex and multipronged plan to revise the state’s Medi-Cal program and prepare California to implement national health care reform.

California stands to receive about $2 billion a year in federal money over the next five years in the agreement. Roughly half of that is in new money — money beyond what the federal government currently pays per year to help fund Medi-Cal, California’s Medicaid program.

This state has led the nation in how rapidly it has tried to adapt to and adopt national health care reform, and the Medicaid waiver reflects California officials’ innovative approach.

When the agreement is announced, a few of those innovative elements may or may not be included:

  • A requirement that seniors and persons with disabilities in Medi-Cal be assigned as mandatory enrollees to managed care plans;
  • New health care delivery models for children eligible for California Children’s Services;
  • Pilot projects for managing the care of patients with dual eligibility — that is, people who are enrolled both in Medi-Cal and Medicare;
  • Coverage expansion and enrollment demonstration projects for coverage of low-income individuals who are not otherwise eligible for Medi-Cal;
  • More funding for public hospitals, including investment pools where payments could be tied to quality and efficiency improvements;
  • Expansion of the number of childless adults covered in the Medi-Cal program, as well as the number of those with annual incomes falling between 133% and 200% of poverty level; and
  • More funding for the state’s safety net system, including infrastructure improvements.

Legislators in Sacramento passed two bills last month to support implementation of the waiver: AB 342 by John Perez (D-Los Angeles) and SB 208 by Darrell Steinberg (D-Sacramento) formalize the agreement, and alter state law to help clear up any ambiguity or contradictive language in California statutes, which is intended, in part, to limit lawsuits over the new program.

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Capitol Desk Medi-Cal