CMS approves $6.2B waiver for California Medicaid expansion

California has officially gotten the green light on its waiver to transform and expand its Medicaid program, known as Medi-Cal.

The Centers for Medicare & Medicaid Services (CMS) approved its five-year, $6.2 billion federal 1115 waiver, which means the state can move forward on four reform initiatives over the next five years.

The program, known as Medi-Cal 2020, provides four initiatives that are designed to continue to improve the quality and value of care provided to California's Medi-Cal beneficiaries. These initiatives include:

  • A Public Hospital Redesign and Incentives in Medi-Cal program, which will improve the quality and value of care provided by California's safety net hospitals and hospital systems
  • A Global Payment Program that streamlines funding sources for care for California's uninsured population and creates a value-based mechanism to increase incentives to provide primary and preventive care services, as well as other high-value services
  • A Whole Person Care Pilot program to support local and regional efforts to integrate the systems and improve the care provided to Medi-Cal's most high-risk beneficiaries
  • A Dental Transformation Initiative to improve access to dental care and reduce preventable dental conditions for Medi-Cal beneficiaries

Of course, the initiatives come with a set of stipulations, which include independent analyses of the Medi-Cal program and waiver programs, as well as an evaluation of access within Medi-Cal managed care. Also, California must have processes in place to coordinate with the Medicare program for Medicare-Medicaid beneficiaries.

"Medi-Cal 2020 embodies the shared commitment between the state and the federal government to support the successful realization of some of the most critical objectives for improving our healthcare delivery system," the report says.

Medi-Cal has recently been under scrutiny, with allegations that it has denied equal access to healthcare to Latino Californians and an increasing number of complaints regarding balance billing.

To learn more:
- here is the CMS report

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