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Photo: Natividad Medical Center

Overview

Medicaid, or Medi-Cal in California, is a federal-state partnership to provide coverage to low-income Californians, with rules set forth by federal statute and through federal regulation. Medicare is a federal coverage program for seniors and persons with disabilities.

Coverage expansion through the Affordable Care Act (ACA) has helped transform how public health care systems provide care in California’s communities. The ACA offered an unprecedented expansion of insurance coverage to low-income Californians, with Medi-Cal enrollment increasing from 8.6 million prior to the ACA to over 13 million in 2016. CAPH is advocating for the preservation of this progress.

CAPH engages in federal advocacy related to the Medicaid and Medicare programs on issues such as hospital, physician, and clinic reimbursement, quality, managed care, prescription drugs, and perhaps most importantly, around the ability to test new innovative approaches to care through Medicaid 1115 waivers.

In 2016, California finalized a new agreement with the Centers for Medicare & Medicaid Services (CMS) for a new, 5-year 1115 waiver, called Medi-Cal 2020. This waiver is a critical source of support for public health care systems, but at the same time represents one aspect of the Medicaid program among many others. CAPH has also been actively engaged in responding to and working to implement a federal regulation finalized in 2016 on Medicaid managed care, regulations on a new value-based reimbursement system for physicians in Medicare (the so-called “MACRA” rule), and on regulations for how uncompensated care is measured.

Later in 2016 and into 2017, CMS is slated to release regulations on important topics such as supplemental payments, as well as implementing cuts to Medicaid Disproportionate Share Hospital (DSH) funding as mandated by the Affordable Care Act.

CAPH’s comments, letters, and advocacy materials on federal Medicaid and Medicare issues are available below.

Major Issues and Comment Letters