Federal officials approve California's $6.2B 1115 waiver

December 31, 2015

CMS officially approved a five-year, $6.2 billion federal 1115 waiver for California, also known as Medi-Cal 2020. The waiver approval means California can move forward on four reform fronts over the next five years. The approved proposal includes:

  • Up to $3.27 billion in performance incentives for the state's public hospitals. The plan is called PRIME - Public Hospital Redesign and Incentives in Medi-Cal - and it's the next step beyond the previous waiver's DSRIP (Delivery System Reform Incentive Program) allowance;
  • $1.5 billion over five years for the Whole Person Care pilot program targeting heavy utilizers of services, particularly emergency services;
  • $1.4 billion for the Global Payment Program Pilot. It combines money from the Safety Net Care Pool and Medicaid Disproportionate Share Hospital funding and aims to incentivize cost-effective primary care rather than financially rewarding hospital-based care; and,
  • Funding for dental system reforms in the Dental Transformation Incentive Program.

Related News:
California gets $6.2 billion Medicaid transformation waiver - Modern Healthcare
Arkansas governor asks feds to explore Medicaid expansion changes - NPR
Arkansas governor asks for limits on Medicaid plan - The Associated Press
Additional $129M needed to hold off cuts to South Carolina Medicaid services, reimbursements - The Post and Courier
Some GOP governors flip for Medicaid funds - The Fiscal Times