The Medi-Cal waiver as a bridge…

We’ve reported on the pending negotiations between the state and federal government around a Medi-Cal waiver, setting the rules and defining the resources available for the program that now covers over 7 million Californians, and will cover two million more under health reform.

California Healthline’s Think Tank asked us and other stakeholders–including allies like Gary Passmore of the Congress of California Seniors and Elizabeth Landsberg of the Western Center for Law and Poverty–to describe the challenges and opportunities as we enter the final month of the current waiver, and as there becomes a tug-of-war over final terms and conditions.

Health Access California, which has been a named participant in the Medi-Cal Waiver Stakeholder Advisory Committee and several technical workgroups, has had top three goals we are looking from the waiver:
1) A bridge to health reform, in terms of early enrollment and expansion of coverage;
2) Bringing in new resources to the state of California and particularly funding for the safety-net, so it can survive and prosper under reform; and
3) Providing consumer protections for those in Medi-Cal, especially seniors and people with disabilities who are having their care shifted;

Here’s our essay on the prospects:

On Jan. 1, 2014, at least two million Californians will become newly eligible for Medi-Cal; but this is not to say that they will magically be enrolled when the ball drops in Times Square. Without carefully laying the proper groundwork, this and other provisions of health reform law won’t have their full impact.

How to best make this transition for Medi-Cal, which currently serves more than seven million Californians — including low-income children, parents, seniors and people with disabilities — is just one of the key goals through the current negotiations between the state and federal governments over the program’s next five years. The stakes are high on these and other issues, all considered as part of discussions around a new Medicaid waiver.

In addition to being ready to expand the program, the waiver is the key vehicle for bringing in new federal funds for California’s beleaguered and overstretched safety net of health care providers. After years of running the Medicaid program with the lowest per-patient spending in the country, the state of California is currently requesting an additional $2 billion a year for the next five years from the federal government. Those resources would help our public hospitals and other key providers weather the storm of budget cuts and start to prepare for the many changes under health reform.

Some of those resources will be used to expand county-based initiatives to provide a medical home to low-income adults who now don’t qualify for Medi-Cal. The state has proposed that starting next year counties be able to use a portion of the dollars they already spend on indigent care to draw down these new federal funds. Even more exciting than getting hundreds of thousands of Californians care for the first time, these county-based efforts can — if done right — serve as a bridge to reform, having all these folks ready to get full Medi-Cal coverage in January 2014.

We need to go further and set an explicit goal to have more than a majority –over one million — of those newly eligible Californians enrolled on day one. Given that the federal government will pick up 100% of the costs for these newly insured for the first three years, the state of California has every incentive to get people in the door as soon as possible. We would be leaving money on the table in Washington, D.C., if we don’t. To prepare, we should implement early expansions of programs that can be shifted to Medi-Cal and start pre-enrolling people early as well. It’s an exciting opportunity, but only if we take advantage of it.

The waiver also seeks to change the way care is delivered for some, most particularly seniors and people with disabilities. One proposal would shift such vulnerable populations into more “organized delivery systems,” including Medicaid managed care plans. While there is certainly room for improvement for these patients, particularly on coordinating care if it’s done right, we need to ensure that the health plans are ready to care for this new population. We need to ensure that doctors’ offices can accommodate people with disabilities and that health plans have the adequate number of specialists to meet these patients’ specific needs. We need to ensure the transition is smooth for the patient, with no interruptions in care. We are urging that the final waiver include stronger consumer protections for these patients who need them the most.

In short, the waiver is full of both opportunities and challenges. The new federal health law opens new possibilities and potential, and we must make sure that through the waiver, the next five years of Medi-Cal helps fulfill its promise.

Read more:

For many more details about the Medi-Cal waiver, the Department of Health Care Services has a robust website of materials.

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

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