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§1115 Waiver Update: The Low Income Health Program

At the Waiver Stakeholder Advisory Committee meeting in Sacramento yesterday, Jalynne Callori, Chief of the Low Income Health Program (LIHP), provided an update on county LIHP timelines and application/enrollment processes.

Former CI Counties

The ten “legacy” counties (counties that implemented Coverage Initiatives under the 2005 waiver) executed their contracts on September 30, 2011 and implemented their Medicaid Coverage Expansion (coverage for those up to 133% FPL) programs on July 1, 2011. The legacy counties include Alameda, Contra Costa, Kern, Los Angeles, Orange, San Diego, San Francisco, San Mateo, Santa Clara, and Ventura. Alameda, Contra Costa, Los Angeles, Orange and Ventura are also implementing the Health Care Coverage Initiative (coverage for those up to 200% FPL). Together, the legacy counties have 196,471 people enrolled (as of August 2011).

All Other Counties

The non-legacy counties are only implementing MCE and have the following implementation dates:

Riverside: 1/1/2012

San Bernardino: 1/1/2012

Merced: 2/15/2012

Monterey: 2/15/2012

Placer: 2/1/2012

Sacramento: 2/1/2012

Santa Cruz: 1/15/2012

County Medical Services Program: 1/1/2012

California Rural Indian Health Board: 7/1/2012

San Luis Obispo: 4/1/2012

Counties with pending applications include Yolo, San Joaquin, Santa Barbara, Stanislaus, and Tulare. These five counties are assessing the feasibility of implementing a LIHP and are actively working with DHCS. Pasadena Department of Public Health decided not to run a citywide LIHP and will be merging with Los Angeles County’s program. Fresno County is considering re-application.

Counties implementing LIHP must meet 25 deliverables addressing geographic and timely access standards, appeals processes, add-on services, maintenance of effort (MOE), cultural competency standards, etc.

Notable Achievements and Challenges

Los Angeles has implemented a “Fast Track Pass” that allows those who have completed 90% of their application to stand in a shorter line at the clinic to finish their application and enroll. San Mateo has implemented strategies for the uninsured in a behavioral network. Challenges have included retention, issues with the paper-based application (especially in LA), and data/IT limitations.

Technical Assistance

Blue Shield of California Foundation (BSCF) is offering implementation grants. Sixteen counties have applied. In addition, DHCS is hosting ongoing meetings with counties to discuss and assist with their implementation efforts.

Ryan White Issue

DHCS has requested an amendment to the waiver to access more federal funding to focus on the needs of AIDS patients. They are also working with advocates to reduce pharmacy costs and exploring ways to implement Medi-Cal drug pricing opportunities.

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