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County LIHP Proposals: Summary and Analysis

Introduction

A significant component of the new §1115 Waiver, the Low Income Health Program (LIHP) presents California counties an opportunity to receive tens of millions of dollars in federal matching funds to provide coverage for their medically indigent adult (MIA) populations.  In essence, the LIHP is an early start to one of the key coverage expansion components of the Patient Protection and Affordable Care Act (PPACA).  If they participate in the LIHP, counties will identify MIAs, have additional resources to pay for uncompensated services, develop new delivery systems, increase access to care, and transition the MIA population to either the Medi-Cal program or California’s new Health Benefit Exchange starting on January 1, 2014.

The LIHP actually consists of two separate programs: the Medicaid Coverage Expansion (MCE) and the Health Care Coverage Initiative (HCCI). The MCE will provide coverage for adults ages 19 – 64 with incomes under 133% of poverty.  Federal match for the MCE is unlimited.  The HCCI provides coverage for adults from 19 – 64 with incomes between 133 and 200% of poverty, and expenditures for the HCCI come from the safety net care pool (SNCP), which is capped at $630 million.[1] Only citizens and legal permanent residents are eligible for full benefits in both the MCE and HCCI.

Counties have the option to choose whether and in which programs they want to participate, based in large part by the amount of local resources available for this effort.  Counties that initiate the MCE and/or HCCI are required to cover the following services:

Core Services MCE HCCI
Medical Equipment and Supplies Yes Yes
Emergency Care Services Yes Yes
Acute Inpatient Hospital Services Yes Yes
Laboratory Services Yes Yes
Outpatient Hospital Services Yes Yes
Physical Therapy Yes Yes
Physician Services Yes Yes
Prescription and Limited Non-prescription Meds. Yes Yes
Prosthetic and Orthotic Appliances and Devices Yes Yes
Radiology Yes Yes
Mental Health Benefits Yes No
Non-Emergency Medical Transportation Yes No
Podiatry Yes No

[1] $180 million in federal funds will be available for the first three program years to provide services for eligible HCCI enrollees. In program year four, ending December 31, 2013, federal funds in the amount of $90,000,00 million will be available.  From http://www.dhcs.ca.gov/provgovpart/Documents/LIHP/Applications/ProgramRequirementsandApplicationProcessREV01-25-11.pdf

 

Continued in full text download below…

County LIHP Proposals County LIHP Proposals.pdf

 

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