Medi-Cal Waivers Discussion Guide

October 3, 2019

As noted in the recent ITUP issue brief, Mapping the Future of Medi-Cal, What’s Next? published in March 2019, California’s Medicaid program, Medi-Cal, is at a crossroads as the state navigates the changing federal context, upcoming federal deadlines and daunting system challenges.

Among the most significant issues the state faces are the expiration of two federal Medicaid waivers at the end of 2020: Medi-Cal 2020, California’s current Section 1115 waiver, and the 1915 (b) Specialty Mental Health services waiver. The waivers underly major elements of the Medi-Cal program, including managed care programs for physical and behavioral health services (mental health and substance use disorder (SUD) services) and the financing and performance of the state’s public health care safety net.

Given the sweeping nature of the existing waivers, and recent changes in federal rules affecting Medicaid waivers and managed care, the upcoming expiration of the waivers raises significant issues for the future of Medi-Cal and could require a major restructuring of key aspects of the program.

This discussion guide is a companion document to the Mapping the Future issue brief, and focuses on the waivers, and the state process for addressing the issues presented by the 2020 deadline, as policymakers and stakeholders consider the implications and next steps for Medi-Cal.

Workgroup Discussion Questions

  1. What has worked well with the current Medi-Cal 2020 and Specialty Mental Health waivers? What have been the
    barriers and challenges to effectively serving the needs of Medi-Cal beneficiaries and administering the programs
    covered in the waivers?
  2. What are the fiscal and program implications of increasing the Medi-Cal services and programs delivered through
    managed care? For Medi-Cal beneficiaries? For counties and the state-county relationship? For managed care
    plans (MCPs)? For state oversight of the Medi-Cal program and MCP accountability?
  3. What opportunities are there going forward, through waivers or related program changes, for improving the
    integration of physical and behavioral services provided through managed care? What lessons learned and best
    practices can inform those efforts?
  4. How can the expiring waivers facilitate the review and evaluation of existing program structures and managed care
    delivery models? Consideration of alternative models, regional approaches or consolidation of existing models?
  5. As the state-level conversation unfolds over the next year, what transformative goals can the state set to inform
    and inspire deliberations on the future of Medi-Cal?

Medi-Cal Waivers Discussion Guide

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