California’s next §1115 waiver provides an important opportunity to improve health outcomes for over 10 million Californians. We wanted to share our thinking on possible directions. We have completed our nine regional workgroups throughout the state and our stakeholder convenings in Southern California counties. So these comments are informed by the diverse, passionate and interesting ideas we heard, the discussions we have held and reactions we have received to the California waiver outline and the CMS approved New York DSRIP waiver.
We would encourage a large and transformative waiver as opposed to a small, targeted one. Just as the Bridge to Reform set California on the path to early and successful enrollment, we would urge that the next waiver focus on dramatically improving patient outcomes now that we have the expanded Medi-Cal coverage and managed care platforms in place to do so.
Based on our workgroups, there is a great deal of support at the local level for improving the care and outcomes of care to the newly insured. There is agreement that waiver renewal is a terrific opportunity to improve the functioning of Medi-Cal managed care, which has expanded greatly in terms of covered lives and the complexity of the medical conditions covered, and now needs to focus on further improving health outcomes. With the next round of the §1115 waiver our goal can and should be to achieve excellent outcomes for all the newly insured enrolled with all the participating safety net providers. There is widespread doubt that significant cost savings can be achieved given the already low levels of Medi-Cal spending, but wide consensus that improved outcomes and better quality care are achievable.