The future of Medi-Cal, part 1…

The state Department of Health Care Services had its first official public forum today on a new Medi-Cal “waiver,” which will determine the funding and structure of the program for the next five years. They reviewed a draft concept paper, released on October 19th, that includes at its core a shift of many Medi-Cal beneficiaries to mandatory managed health care plans or other “medical homes” as a way to slow the continued growth of Medi-Cal costs.

The plan, under which the state will seek a waiver from the federal government from certain rules guiding Medi-Cal spending, was developed by the department at the behest of the Governor and the Legislature. More information on the Medi-Cal waiver is on the Department’s website, at:

As part of the 2009-2010 budget deal, the Legislature had passed AB xxxx 6, which Governor Schwarzenegger signed, requiring the DHCS to embark on a process for a renewed waiver from the federal government for our Medi-Cal program, with a goal to achieve long-term cost savings.

The restructuring entails securing a waiver from Washington in order to continue receiving matching federal dollars for public health care. It comes as Congress is closer than it ever has been to paving the way to national health care reform.

Department executives said a waiver would allow the Medi-Cal program to operate more efficiently to achieve long-term cost savings while continuing coverage for California’s older adults and chronically ill. This is the costliest population medically because of its ongoing need for health care.

Should health care reform emerge from Washington in a form that would expand Medi-Cal coverage to insure more Californians, an expansion likely would not occur for several years. This waiver for the next five years has the opportunity to be a bridge to that reformed health care system.

Monday’s hearing on the waiver demonstration project marked the first public hearing on the proposal. Dozens of advocates representing patients, hospitals, care providers, community clinics, the uninsured and others – including Health Access California – pressed DHCS for detailed answers to their questions about the proposal.

Stakeholders have until November 14th to submit their comments, positions and suggestions to DHCS officials. The department will convene a stakeholder committee and a panel of technical advisors to examine the waiver proposal closely and suggest any changes.

DHCS said its goal is to present proposed milestones for the waiver demonstration project to the Centers for Medicare & Medicaid Services by August 2010. Officials admitted that they did not have an exact date for when changes take place, should the waiver be approved as proposed.

Health Access will have more written materials about the substance of the draft waiver concept paper shortly.

Health Access California promotes quality, affordable health care for all Californians.

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