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Waiver Reports

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

Summary of the Terms and Conditions for California’s Section 1115 Waiver Renewal

California’s Section 1115 Waiver Renewal Terms and Conditions has six elements: managed care expansion; preventive dental care for children ($750 million); whole person care pilots ($1.5 billion); substance abuse treatments (Drug Medi-Cal); global budgets for public hospitals; and PRIME upgrades ($7.5 billion) in managed care readiness for county, UC, and […] more

California’s §1115 Waiver Renewal

California’s §1115 waiver recently expired on October 31, 2015, and HHS granted a temporary extension of the waiver until December 31, 2015.  On October 31, 2015, DHCS and CMS announced a conceptual agreement that outlines the major components of the waiver renewal. There are several improvements in the renewed waiver, while also room to continue […] more

ITUP Summary of DHCS Waiver Renewal Concepts

The concept paper includes the following: Delivery System Transformation and Global Safety Net Payments for the Remaining Uninsured. Within the Delivery System Transformation are the following six sub-elements: managed care transformation, fee for service transformation, public safety net transformation, workforce development, housing and supportive services, and regional whole person care […] more

Upcoming Waiver – Thoughts From Southern California (UPDATED)

This four part series examines the upcoming Medicaid Waiver. Section 1 is background on waivers; Section 2 reviews California’s implementation of the Affordable Care Act; Section 3 provides 2012 data on Southern California’s safety nets on the eve of ACA implementation, and Section 4 discusses the 11 key issues brought […] more