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California Reaches Agreement on Medi-Cal Waiver Renewal

California Reaches Agreement on Medi-Cal Waiver Renewal

On Saturday, the California Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS) agreed in principle to a five-year, $6.2 billion waiver for California’s Medicaid program. The new waiver, or “Medi-Cal 2020,” is good news for California as it will provide the state with much needed funds to begin the next phase of Affordable Care Act (ACA) implementation – equitably improving health care quality and reforming delivery so that it is more targeted and efficient.

The waiver agreement, while a significant achievement, is lower than California’s original request for $17 billion in funding and is almost $1 billion lower than the state’s revised waiver request of $7.25 billion. CMS has granted the state a temporary two-month extension of the current waiver until December 31st while state and federal officials work out the remaining details of the new waiver.

The conceptual agreement includes the following core elements:

  • Total funding for the 1115 waiver is set at $6.2 billion over five years, with more than half ($3.3 billion) designated for a public hospital incentive program that includes hospitals operated by municipalities and other local health care districts.
  • Though the state requested $1 billion for a Global Payment Program (GPP) to cover services to the uninsured in designated public hospital systems, the waiver agreement includes $236 million for the first year but left open the possibility of additional funding in the future.
  • A dental transformation incentive program will receive $750 million over five years.
  • The Whole Person Care Pilot program, which would be a county-based, voluntary program to provide more integrated, targeted care for high-risk, vulnerable populations, will receive $1.5 billion in federal funds over five years.
  • The waiver additionally will require an independent assessment of access to care and network adequacy for Medi-Cal managed care beneficiaries and independent studies of uncompensated care and hospital financing.

For more details you can access the negotiated agreement here.

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