Medi-Cal 2020/Health Homes

Medi-Cal 2020 is the name of California’s 5-year federal 1115 waiver, which allows the state to waive certain elements of the Medicaid program in order to test out projects and demonstrations that support the objectives of Medicaid. Just approved on December 30 2015, the roll out of Medi-Cal 2020 has multiple implications for older adults in Alameda County. Click here to visit the Medi-Cal 2020 web site.

Alameda County will be eligible to implement California’s new Health Homes for Patients with Complex Needs (HHP) in 2018. Part of the Affordable Care Act and coordinated through the Medi-Cal Managed Care Plan(s) in each county, HHP will provide comprehensive care management to a small but high-risk number of Medi-Cal enrollees who have complex chronic conditions including serious and persistent mental illness. To find out more, click here.

Recent Developments

August 9, 2016 – With Alameda County’s successful application for a three-year, $140 million Whole Person Care Pilot, we’ve started a new page in our County Policy Developments section. Click here to go to the new Whole Person Care Pilot page.

January 11, 2016 – On December 30, 2015 the Centers for Medicare & Medicaid Services (CMS) approved Medi-Cal 2020, a five-year $6.2 billion federal 1115 waiver for California. CMS’s 1115 waivers allow states to waive certain elements of the Medicaid program in order to test out projects and demonstrations that support the objectives of Medicaid. California’s prior 1115 waiver – The Bridge to Reform – expired this year, and Medi-Cal 2020 extends this demonstration in new ways.

The approval for Medi-Cal 2020 outlines several of the initiatives that the state sought under the Medi-Cal program aimed at improving quality of care, including:

  • Public Hospital Redesign and Incentives in Medi-Cal (PRIME) – PRIME aims to improve the quality of care individuals receive at Designated Public Hospitals and District Municipal Public Hospitals through changed payment methodologies.
  • Global Payment Program (GPP) – The GPP changes the funding for Designated Public Hospitals to improve the delivery of care to those who remain uninsured in California.
  • Dental Transformation Initiative (DTI) – Medi-Cal dental providers will receive incentive payments for meeting benchmarks in areas such as preventive services and continuity of care.
  • Whole Person Care Pilots – County-based pilots will aim to improve care for high-risk beneficiaries through the integration of the systems that provide physical health, behavioral health, and social services.

The waiver also continues several important state health programs, including Community-Based Adult Services for seniors and people with disabilities needing Adult Day Health Care, Cal MediConnect for Californians in seven counties who are dually eligible for Medi-Cal and Medicare, the Drug Medi-Cal Organized Delivery System and the state’s shift toward Medi-Cal managed care.

We’ll learn more about the implications of Medi-Cal 2020 for older adults in Alameda County in the months to come. In the meantime, DHCS is holding its first stakeholder webinar covering the waiver on January 25, 2015, from 3:00 – 4:30pm (registration information coming soon). Click here to visit the Medi-Cal 2020 web site.

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