Release on CMS interim approval of CA waiver

This is a copy of a stakeholder email sent over the weekend, published here in its entirety.


From: DHCS Director (DIR)@DHCS
Date: Sat, Oct 31, 2015 at 11:55 AM
Subject: DHCS UPDATE: California’s 1115 Medicaid Waiver

To: “

As you know, DHCS and CMS have been in negotiations regarding the renewal of California’s 1115 Medicaid Waiver.  Significant progress has been made and today DHCS and CMS announced a conceptual agreement that outlines the major components of the Waiver renewal, along with a temporary extension to December 31st of the existing Waiver while we specify the details of the renewal through the official Special Terms and Conditions (STCs).
This is a critical step in the Waiver renewal process and we appreciate all of the hard work done thus far with CMS.  However, much work remains as we develop the details of the Waiver programs and components through the STCs.
The total initial federal funding in the renewal is $6.218 billion, with the potential for additional federal funding in the global payment program to be determined after the first year.

The conceptual agreement includes the following core elements:

  • Global Payment Program (GPP) for services to the uninsured in designated public hospital systems (DPH).  The GPP converts existing DSH and Safety Net Care Pool (SNCP) uncompensated care funding – which is hospital-focused and cost-based– to a system focused on value and improved care delivery.  The funding of the GPP will include 5 years of the DSH funding that otherwise would have been allocated to DPHs along with $236M in initial federal funding for one year of the SNCP component.  SNCP component funding for years two through five would be subject to an independent assessment of uncompensated care.
  • Delivery system transformation and alignment incentive program for DPHs and district/municipal hospitals (DMPH), known as PRIME (Public hospital Redesign and Incentives in Medi-Cal).  The federal funding of PRIME for the DPHs is a total of $3.2655 billion over the five years of the Waiver, which includes $700 million for each of the first three years, $630 million in year four, and $535.5 million in year five. The federal funding for the DMPHs is a total of $466.5 million over the five years of the Waiver, which includes $100 million for each of the first three years, $90 million in year four, and $76.5 million in year five.
  • Dental transformation incentive program.  The funding of this program is $750M in total funding over 5 years.
  • Whole Person Care Pilot (WPC) program which would be a county-based, voluntary program to target providing more integrated care for high-risk, vulnerable populations. The funding of this program would be up to $1.5B in federal funds over 5 years.
  • Independent assessment of access to care and network adequacy for Medi-Cal managed care
  • Independent studies of uncompensated care and hospital financing.