Medi-Cal 2020 Overview
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 new federal funding through programs that will shift the focus away from hospital-based and inpatient care, towards outpatient, primary and preventative care – in other words, from volume to value.
Section 1115 of the Social Security Act allows states to waive certain federal statutory Medicaid program requirements or obtain federal matching funds for costs or investments that would not otherwise be allowed under the Medicaid program. This flexibility allows states to test innovative approaches to care, in an effort to improve quality, access, and efficiency. Waivers can cover all, or part, of a state’s Medicaid program.
All Section 1115 Medicaid waivers include three key elements: budget neutrality, sources of non-federal share, and programmatic components.
Medi-Cal 2020 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 and alignment program for California’s public health care systems and district and municipal hospitals
- Global Payment Program, an innovative payment reform program for services to the uninsured in California’s public health care systems
- Whole Person Care, a county-based pilot program to provide more integrated care to the highest-risk and most vulnerable patients in local communities
- 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 preventative and patient-centered care in the right place at the right time to all patients.
