Planned Action on Medi-Cal Services Under a Proposed Federal Waiver

In mid-May, the California Department of Health Care Services (the department that administers Medi-Cal) issued its Implementation Plan for the new §1115 Medicaid waiver. A Medicaid waiver allows the federal government to authorize a pilot or demonstration project that normally would not be allowed under federal Social Security laws and Medicaid regulations. (In California, Medicaid is known as Medi-Cal.)

The new plan addresses four key populations:

The key elements of the new plan are to:

In preparation for the implementation of National Health Care Reform, the new plan proposes to:

The proposed 1115 waiver expansion will extend coverage to the extent that county funding is available. Expansion is slated to initiate in existing coverage areas in February 2011, with new county initiatives to begin in September 2011.  By January, 2012 pilot programs would begin.  Depending on how details are finalized, it could also have major impact on other Medicaid-funded services and programs that California provides mental health community-based services and children's health services. 

The proposal calls for shifting, over a phased-in period of five years, tens of thousands of children and adults with disabilities, the blind, people with mental illness, and seniors into an "organized delivery systems of care" that could use existing managed health care systems or create new systems, including newly developed "enhanced medical home" models. The intent is to dramatically change how Medi-Cal services are delivered to those individuals from the traditional "fee-for-service" model to an "organized delivery systems of care" where costs can be controlled while quality can be maintained and even improved. Of course, family and consumer stakeholder involvement in designing the "organized delivery systems of care" is essential in ensuring that when controlling costs, quality of care will not be compromised, but will, instead, improve as intended.

In a letter to David Maxwell-Jolly, Director of the Department of Health Care Services (Medi-Cal), NAMI California Executive Director, Dr. Trula LaCalle, wrote that certain elements must become part of all pilot programs and statewide programs.  She named the following elements as desirable:

NAMI California continues to follow the progress of the 1115 Waiver and will submit comments when needed.  As implementation of the new waiver evolves, NAMI California members will receive updates.