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Medi-Cal

California’s health system includes statewide public coverage programs and special county-based programs: Medi-Cal, Healthy Kids/Healthy Families, and others created under Section 1115 of the Social Security Act.


ITUP Analysis and Summary of the §1115 Waiver Renewal

ITUP has prepared a six-part summary of California’s Medi-Cal 2020 §1115 waiver, which went into effect at the beginning of 2016. The new waiver aims to build off of the successes of the Bridge to Reform waiver, which expired at the end of 2015. The analysis is freely available in […] more

§1115 Waiver Renewal Analysis: Global Payment Program (GPP)

This is part of an ITUP series on the Medi-Cal 2020 §1115 waiver renewal. Before the Medi-Cal 2020 waiver, the federal/local financing of care for the uninsured was anachronistic. It incentivizes treating uninsured individuals at the hospital emergency room (the most expensive setting) at the latest possible stage of illness […] more

§1115 Waiver Renewal Analysis: Public Hospital Redesign and Incentives in Medi-Cal

This is part of an ITUP series on the Medi-Cal 2020 §1115 waiver renewal. Public Hospital Redesign and Incentives in Medi-Cal (PRIME) is an ambitious follow-up program to the successful Delivery System Reform Incentive Pool (DSRIP) for county, district, and University of California hospitals. Up to $7.5 billion will be […] more

Analysis of §1115 Waiver Renewal: Dental Transformation Initiative

This is part of an ITUP series on the Medi-Cal 2020 §1115 waiver renewal. Under the Medi-Cal Dental program, dental services are provided to about 5.5 million Medi-Cal beneficiaries under the age of 20. The program aims to facilitate consistent and easy access to high quality dental services so beneficiaries […] more

Analysis of §1115 Waiver Renewal: Whole Person Care Pilots

This is part of an ITUP series on the Medi-Cal 2020 §1115 waiver renewal. As health care systems are focusing on providing more efficient, high quality care, systems around the country are moving towards more integrated patient care. The addition of the Whole Person Care Pilots (WPC) in California’s new […] more

Analysis of §1115 Waiver Renewal: Managed Care Expansion and Demonstrations Continuation

This is part of an ITUP series on the Medi-Cal 2020 §1115 waiver renewal. The Medi-Cal program has grown from a caseload of 7.9 million beneficiaries in 2012-13 to a projected 13.5 million in 2016-17. About 10 million are currently enrolled in a managed care plan. The plans are reimbursed […] more

Solo and Small Group Physician Practices in California (UPDATED)

Solo and small group (fewer than 10) physician practices are an important piece in California’s healthcare landscape. They serve as access points for consumers to receive healthcare services, emphasize relationship-based continuity of care and serve the geographically and socio-economically underserved. More specifically, solo and small group physicians commonly serve ethnically […] more

Medi-Cal Managed Care: Raising the Bar for Quality and Outcomes

To realize better health outcomes, Medi-Cal Managed Care (MMC) plans have many challenges to confront. Plans must tackle the tasks of ensuring that provider networks are of sufficient size, coordinated, high performing in service quality, and engaging patients to be critical partners in improving their health. These achievements require a […] more

2013 OSHPD Clinic and Hospital Data Summaries

The attachments below are data overviews of OSHPD’s 2013 utilization and financial data for clinics and hospitals. Providers were analyzed by region, as well as by type. For the purposes of our analyses, non-comparable facilities (Kaiser, Shriners) were excluded.                     more

Open Letter on the Next Section 1115 Waiver

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 […] more