This four part series examines the upcoming Medicaid Waiver. Section 1 is background on waivers; Section 2 reviews California’s implementation of the Affordable Care Act; Section 3 provides 2012 data on Southern California’s safety nets on the eve of ACA implementation, and Section 4 discusses the 11 key issues brought up during our convenings and one on one discussions for Southern California stakeholders to consider as California decides what form of a waiver should be sought in 2015.
What is a waiver? 42 USC §1315 (Section 1115 of the Social Security Act) authorizes states to seek waivers of certain specified federal laws – in this case §1902 of the Social Security Act. Typically these are experiments that cost the federal government less (budget neutrality) than it otherwise would have spent, that waive particular components of the Social Security Act, and that deliver better, more cost effective services.
California’s 2010 waiver, known as the Bridge to Reform combined a variety of changes: LIHP (Low Income Health Program), SNCP (Safety Net Care Pool), matches for state workforce programs, matches for state programs for the uninsured, DSRIP (Delivery System Reform Incentive Pool), four CCS (California Children’s Services) pilots and eight Medi-Medi managed care pilots (including managed care for the seniors and persons with disabilities and the Medi-Medis or dual eligibles). The LIHP aspect of the waiver expired at the end of 2013, and SNCP and DSRIP are due to expire in November 2015.
The next waiver does not have much flexibility to increase coverage of or pay for uncompensated care to California’s uninsured because California has already implemented the Medicaid expansion and Covered California quite successfully. The federal government cannot give a waiver to expand emergency Medi-Cal to the undocumented beyond its current scope because those provisions do not appear in §1902 of the Social Security Act. It can give waivers under Section 1115 in 2015 to make the Medicaid expansions work better, and it can give waivers under Section 1332 in 2017 to make Covered California and its intersections with Medicaid and employment-based coverage work better.