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Expanding Coverage to CA’s MIAs

Now that federal health reform has passed, California faces a new challenge: Preparing for its implementation. With 6.5 million reported uninsured in 2006, county systems have long been relied upon to run programs for Medically Indigent Adults (MIAs) – low-income individuals without disabilities or minor children living at home who do not qualify for public programs.

Ten counties in California currently receive a federal match through the §1115 Medicaid waiver to provide care for the MIAs. These counties have created pilot programs that aim to cut costs and improve health outcomes. California is currently seeking to renew this waiver, which expires in August, 2010. Under a renewed waiver, these counties – and possibly others – could use county dollars to draw down a federal match and begin transitioning their systems to meet federal reform provisions in the next few years. This includes transitioning high risk patients to managed care, focusing on primary care and prevention, and improving access to care.

California can benefit from federal reform as early as this month. As of April 1, the state may receive a federal Medicaid match for early expansion to MIAs up to 133% of the federal poverty level (FPL). Starting on January 1, 2011, the government will pay 90% of the cost to provide care coordination and case management to Medicaid enrollees with multiple chronic conditions. As of January 1, 2014, the government will fully fund the cost to expand Medicaid coverage to these individuals up to 133% FPL. By enrolling these patients now using federal matching funds, California avoids barriers due to enrollment and positions itself to maximize federal dollars as reform is implemented.

To read more about using the §1115 waiver as a bridge to federal reform, read our most recent report here and the California Healthline article to which we contributed here.

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