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Photo: Arrowhead Regional Medical Center

Medi-Cal 2020 Waiver

Medi-Cal 2020 is a five year renewal of California’s Section 1115 Medicaid Waiver, which could provide California with more than $7.1 billion in federal funding through programs that shift the focus away from hospital-based and inpatient care, towards outpatient, primary and preventive care – in other words, from volume to value.

SNI worked hand in hand with CAPH and the State of California Department of Health Care Services (DHCS) as the proposal for the Medi-Cal 2020 waiver was being developed, drawing on: feedback from our systems’ leaders on whether the cornerstone programs of the waiver would be truly transformative; input from data leaders on how to structure the reporting requirements of the waiver; and a thorough analysis of state and national benchmarks conducted by clinical experts from across California to help develop targets.

This work continues through the regular convening of expert clinical and informatics advisory committees from across California’s public health care systems, and through ongoing work with the State to refine and clarify the waiver’s reporting structure and requirements.  SNI provides robust support to members focused on helping them meet both the waiver programs’ ambitious performance improvement targets and their challenging reporting requirements.

Programs

The waiver features four new programs that aim to improve care for the state’s Medi-Cal and remaining uninsured patients.

Public Hospital Redesign and Incentives in Medi-Cal (PRIME), a pay-for-performance delivery system transformation program for California’s public health care systems and district and municipal hospitals (Learn about SNI member support)

Global Payment Program, an innovative payment reform program to improve and expand services to the uninsured in California’s public health care systems (Learn about SNI member support)

Whole Person Care, a county-based pilot program to provide better integrated care to the highest-risk and most vulnerable patients in local communities (Learn about SNI member support)

Dental Transformation Initiative, an incentive program to increase the frequency and quality of dental care provided to children

These programs are designed to complement each other in supporting the efforts of California and its public health care systems to create a delivery system that provides preventive, evidence-based and patient-centered care in the right place at the right time to all patients.