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Waiver Implementation Update

At yesterday’s meeting of the §1115 Waiver Stakeholder Advisory Committee, the state and other key groups provided updates waiver implementation efforts.

Low Income Health Program

DHCS Director David Maxwell-Jolly outlined the components of the Low Income Health Program (LIHP) part of the Waiver: (1) the Medicaid Coverage Expansion, and (2) the Health Care Coverage Initiative. He noted that the LIHP will be comprised of:

  • Beneficiary protections akin to Medi-Cal
  • Grandfathering existing beneficiaries
  • Due process
  • Provider timeliness

Director Maxwell-Jolly also stressed the importance of coverage expansion as an opportunity to begin coordinating physical and mental health, and that various counties are already thinking about this kind of integration.

Safety Net Care Pool

The Safety Net Care Pool (SNCP), an important component of the waiver, continues support for uncompensated care in public hospitals by drawing down $600-$700 million per year in federal matching funds. This money will go towards:

  • Support for additional state programs, including county mental health programs and workforce development
  • Infrastructure development
  • Innovation and redesign
  • Population focused improvements, and
  • Urgent improvement care.

These payments give public hospitals strong incentive to improve care and delivery systems. According to Melissa Stafford Jones at CAPH, “It’s the ultimate pay-for-performance. It combines payment reform with accountability for public hospital delivery systems — establishing medical homes, reducing readmission rates, integrating specialty and primary care.” For more on the SNCP and the public hospitals’ reaction, see this article in today’s California Healthline.

Implementation Timeline Update

Enrollment of Seniors & Persons with Disabilities (SPD) in Managed Care:
– Dec 2010: Begin plan capacity and readiness assessments
– Mar 2011: Begin outreach and enrollment campaign
– May 2012: Complete enrollment in managed care

Children with Special Health care Needs
– Jan 2011: Request for Information (RFI) for 4 pilot sites released
– May 2011: RFI responses due, and sites selected by July 2011
– Jan 2012: Pilots begin

– Jan 2011: Notification of LIHP requirements sent to counties
– Mar 2011: Begin LIPH enrollment expansion in existing
Coverage Initiative counties, full implementation in these counties by July 2011
– Sep 2011: Begin LIHP enrollment in expansion counties