The Work Ahead for Public Healthcare Systems



The Opportunity

On December 30, 2015, the federal Centers for Medicaid and Medicare Services (CMS) approved Medi-Cal 2020 – a five year renewal of California’s Section 1115 Medicaid Waiver, which could provide California with more than $6.2 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.

With 1 in 3 residents now enrolled in the Medi-Cal program, and another 3 million who remain uninsured, California has an opportunity through the waiver to maintain its successful implementation of the Affordable Care Act and improve health care delivery for low-income patients.

The Critical Role of Public Health Care Systems

California’s 21 public health care systems (PHS) are central to the success of Medi-Cal 2020. Serving more than 40% of the state’s remaining uninsured and 25% of its Medi-Cal population, these county-owned and operated health care systems and University of California medical centers operate in 15 counties where more than three quarters of the state’s population lives.

Though just 6% of all health care systems in the state, they serve more than 2.85 million patients a year, provide 10.5 million outpatients visits annually, operate more than half of the state’s top-level trauma and burn centers, and train more than half of all new doctors in the state.

Public health care systems’ essential safety net mission and mandate – to provide access to care to everyone, regardless of insurance status, ability to pay, or other circumstance – can only be maintained if these systems can also attract, retain and compete for newly covered patients.

Medi-Cal 2020 is designed to give public systems the incentive and opportunity to achieve these long term strategic goals of supporting their safety net role and their ability to compete. PHS intend to do so by becoming models of integrated care that are high value, high quality, patient-centered, efficient and equitable, with great patient experience and a demonstrated ability to improve health care and the health status of populations.

The vision is ambitious and clear, and California’s public health care systems have embraced the challenge.

This Brief

This brief will provide an overview of the new waiver programs detailed in the Special Terms and Conditions (STCs) of the waiver, viewable at the California Department of Healthcare Services website.