CHA News Article

DHCS Begins 1115 Waiver Renewal Expert Stakeholder Workgroup Meetings
Initial waiver concepts, stakeholder meeting dates and locations included

The California Department of Health Care Services (DHCS) has begun its 1115 waiver renewal expert stakeholder engagement process. California’s current section 1115 “Bridge to Reform” waiver – set to sunset Oct. 31, 2015 – is a five-year demonstration of health care reform initiatives to prepare California for significant changes under the Affordable Care Act (ACA). California is seeking a waiver renewal that will build on the approaches and successes of the existing waiver as it moves forward, with the goal of expanding and improving the Medi-Cal program through delivery and payment system transformation. California will submit its waiver renewal request to the Centers for Medicare & Medicaid Services (CMS) in spring 2015 (requests to CMS must be submitted at least six months before the end of the current demonstration). DHCS has engaged stakeholders in the waiver renewal design and has outlined the stakeholder engagement process, including meeting dates and locations on its website. CHA has been appointed to serve on many of the 1115 waiver renewal stakeholder workgroups and will continue to provide members with updates on this process in CHA News.

California is currently in the fourth year of its 1115 waiver, designed to: 1) strengthen California’s health care safety net; 2) maximize opportunities to reduce the number of uninsured individuals; 3) optimize opportunities to increase federal financial participation and maximize financial resources to address uncompensated care; 4) promote long-term, efficient, and effective use of state and local funds; 5) improve health care quality and outcomes; and 6) promote home and community-based care.

In July, DHCS shared its initial waiver renewal concepts with stakeholders, with the stated goals to: 1) further delivery of high-quality and cost-efficient care for Medi-Cal members, 2) ensure the long-term viability of the delivery system post-ACA expansion, and 3) continue California’s momentum and successes in innovation achieved under the current “Bridge to Reform” waiver. DHCS’ initial concepts of the waiver renewal are built around the core objectives of strengthening primary care delivery and access, avoiding unnecessary institutionalization and services by building the foundation for an integrated health care delivery system that incentivizes quality and efficiency, addressing social determinants of health, and using California’s Medicaid program as an incubator to test innovative approaches to whole-person care.

DHCS has developed several concepts for consideration as part of its waiver renewal to achieve the goals above, including: 1) a federal/state shared savings initiative, 2) payment/delivery system reform incentive payment programs, 3) safety net payment reforms that support coordinated and cost effective care for the remaining uninsured, 4) Federally Qualified Health Care payment and delivery reform, 5) a successor Delivery System Reform Incentive Payment program, 6) California Children’s Services program improvements, 7) Medicaid-funded shelter for vulnerable populations, and 8) a workforce development initiative.