Federal Officials Approve New “Medi-Cal 2020” Waiver Renewal

Earlier today the U.S. Centers for Medicaid and Medicare Services (CMS) officially approved California’s “Medi-Cal 2020” waiver renewal for the next five years, providing new resources and new flexibility to deliver better care for the millions of low-income Californians who rely on Medi-Cal for their health coverage. The new waiver also includes support for a “smarter safety net” and innovative care solutions for the uninsured. The announcement comes one day before the extended deadline for final renewal.

A waiver is a formal request by a state to the Secretary of Health and Human Services to waive specific Medicaid program requirements in order to test new ways to deliver care without spending more federal dollars than would otherwise be spent. Since the 1990s, California has made extensive use of waivers to further health reform goals or more recently, to implement reforms (including the Medicaid expansion) ahead of schedule and to extend their reach. Under the Medi-Cal 2020 waiver renewal, California will have $6.2 billion in new funds and likely more over the next five years, to pursue innovations in health delivery, dental care, safety-net services for the remaining uninsured, and ‘whole person care’ through integration with other human services.

Key provisions of Medi-Cal 2020 include:

  • The Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program will build on the success of the state’s Delivery System Reform Incentive Program (DSRIP), a first for the nation. Under PRIME, Designated Public Hospital (DPH) systems and District Municipal Public Hospitals will pursue innovations in critical areas like physical and behavioral health integration and outpatient primary and specialty care delivery. PRIME also moves the DPHs toward value-based payment methodologies over the course of the waiver.
  • The Global Payment Program (GPP) provides incentives mainly to the county-based health care systems to improve the way care is delivered to the remaining uninsured. The counties, too, will move toward value-based payment structures and incentives to deliver primary and preventive care, as opposed to hospital-based care, to the remaining uninsured. With the resources set aside in the GPP, more California counties can leverage local partnerships to provide comprehensive care to the remaining uninsured (see our map for details).
  • Under the Dental Transformation Initiative (DTI), qualified Medi-Cal dental providers will have incentive payments to provide preventive services and better continuity of care to Medi-Cal patients.
  • Whole Person Care pilot programs, funded with up to $1.5 billion over 5 years, would explore integrating health with other human services. Many of the highest risk patients, for example homeless people or people leaving incarceration, cannot benefit from care without additional supports like housing services or food assistance. It’s one thing to diagnose a homeless patient with diabetes—but that patient won’t get very far in the prescribed treatment without a roof over her head. Under the whole person care pilot provision, counties will engage other social services and supports to help their most vulnerable patients fully benefit from care.

The waiver renewal also re-authorizes the Medi-Cal managed care program, Community-Based Adult Services, the Coordinated Care Initiative, and Drug Medi-Cal.

Finally, the waiver renewal includes an independent assessment of access to care and network adequacy for those enrolled in Medi-Cal managed care plans. Health Access welcomes this assessment and believes it will complement current efforts to ensure timely access to care across the state.


The California Department of Health Care Services (DHCS) will convene a stakeholder webinar to review the requirements of Medi-Cal 2020 and answer questions.

When: January 25th 3 p.m. to 4:30 p.m.

Where: Details, including the waiver approval letter and Special Terms & Conditions are available on DHCS’s website.