New Coverage, and Investments on our Health System, Under New Medicaid Waiver

Governor Schwarzenegger just announced the finalization of a “Medicaid waiver” agreement between the state and federal government. This new Medicaid waiver is a big deal… it’s a plan for the next five years for Medi-Cal, key state-federal program that covers over 7 million low-income California children, parents, seniors and people with disabilities, and is a central funding source for our entire hospital and health care system.

With this new Medicaid waiver, California takes another important step toward an improved and reformed health care system. The new waiver includes key investments in the health care system on which we all rely, and allow for the early expansion of coverage as a transition to 2014. Of particular interest, the waiver allows counties to get federal matching funds to cover low-income Californians, helping those families, our health care system, and our economy, and providing a bridge to health reform in 2014.

Patient advocates had three goals for this waiver:
1) to win needed investments for our state and for our struggling health care system,
2) to start expanding coverage options and other benefits of the new federal law as a “bridge to health reform,” and
3) to ensure consumer protections for those in Medi-Cal, especially seniors and people with disabilities who are being shifted to managed care.
We made progress on all fronts, even while there is always more work to do.

California’s five-year plan for Medi-Cal was expiring, and it was crucial that the new five-year plan included an aggressive effort to make sure Californians can take advantage of the benefits of the new federal law.

In the Schwarzenegger Administration’s release, here’s their breakdown of the new waiver:

California’s waiver, officially titled California’s “Bridge to Reform: A Section 1115 Waiver Proposal,” advances the state’s health care goals in four specific areas:

1. Expands Coverage to More Uninsured Adults
· The waiver allows all counties to participate in the successful county-based Health Care Coverage Initiative. This initiative offers comprehensive benefits to low-income adults currently ineligible for Medi-Cal coverage, and DHCS estimates that as many as 500,000 adults aged 19 to 64 could enroll. Under the new waiver, counties participating in the initiative will immediately begin phasing in coverage for these childless adults. In 2014, these enrollees will transition into full Medi-Cal coverage or into the new California Health Benefit Exchange established by recent legislation enacted by the Governor under the Patient Protection and Affordable Care Act.

2. Ensures Funding to Support Access to Care
· The waiver expands on the existing Safety Net Care Pool to provide payment for uncompensated care and ensure support for safety net hospitals and other critical state health programs that deliver services to the uninsured.

3. Improves Care Coordination for Vulnerable Populations
· Under the waiver, up to 400,000 seniors and persons with disabilities will have access to more organized delivery of care in managed care plans, offering them more accountable and coordinated services and delivering improved health outcomes.
· In later years of the waiver, the state will pilot organized systems of care for children with special health care needs to improve care coordination, consumer satisfaction, health outcomes and cost effectiveness.

4. Improves Quality of Care
· The waiver establishes a Delivery System Reform Incentive Pool to support California’s public hospitals in transforming their delivery systems to improve access, care coordination and health outcomes of the patients they serve. Pool investments in infrastructure improvements and system innovation and redesign will be tied to hospital improvements in care coordination, quality and efficiency.

To learn more about the details of California’s “Bridge to Reform: A Section 1115 Waiver Proposal,” please click here.

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

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