Questions about Medi-Cal re-procurement and the 1115 waiver

The Department of Health Care Services (DHCS) has pulled the timeline for Medi-Cal re-procurement from its website. The DHCS website says “There are currently no active procurements out for bid or application at this time. The schedule is currently being reviewed and will be released in the near future.”

In an email to State of Reform, DHCS says:

“Our office does not have any other information regarding waivers.  The January 30, 2019 update found on our website is the most recent information that our office has regarding the Medi-Cal Managed Care Request for Proposal project at this time.”

Mari Cantwell is the Director of Medi-Cal and Chief Deputy Director of Health Care Programs at DHCS.  She addressed questions about the re-procurement at a conference this week.  She also explained that there was some question about submitting an 1115 waiver renewal application to CMS.

Cantwell said that among the options DHCS is considering is not submitting a waiver at all.  She discussed the difficulty of building a waiver package that could reasonably be expected to receive federal approval while still moving the state forward on the policy aims of the governor.  Cantwell stated:

“If someone could show me how we could do this, it would be great.”

Other ideas include a minimalist waiver package that focuses on programs that the state knows CMS supports.  This could include the Global Payment Program, which allows for more money to flow to uninsured in primary care settings, and further integration of behavioral health services.

In the meantime, state Medi-Cal plans like Health Net, Promise Health Plan, and L.A. Care, as well as others, are left with some level of anxiety about the future.  California is a state with a wide range of implementation models for Medi-Cal.  It’s possible, however, that one or two models could be selected as a result of policy in the administration, and expanded statewide without a procurement process.  This was a model employed in New York’s approach to Medicaid reform.