CMS ap­proves Cal­i­for­nia’s $6.2 bil­lion Med­i­caid waiver

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dickson

The CMS has signed off on Cal­i­for­nia’s Med­i­caid waiver, along with its de­ci­sion to re­new ex­tra fund­ing

that sup­ports the state’s pub­lic safety net hospi­tals for only one year in­stead of five.

As part of the waiver, the state will re­ceive $6.2 bil­lion to sus­tain ef­forts to re­form its Med­i­caid pro­gram un­der a mas­sive trans­for­ma­tion waiver that ex­pired on Oct. 31.

The new waiver also in­cludes $3.3 bil­lion to help pub­lic safety net hospi­tals launch and main­tain de­liv­ery-sys­tem re­forms, in­clud­ing in­fra­struc­ture de­vel­op­ment, sys­tem re­design, and im­prove­ments tar­get­ing clin­i­cal out­comes and pop­u­la­tion health. The fund­ing to help those hospi­tals shoul­der the bur­den of un­com­pen­sated care was re­newed for only one year in­stead of five like the other pro­vi­sions.

Af­ter the first year, the CMS will re­con­sider fund­ing lev­els based on two re­ports. The first re­port, due May 15, will fo­cus on un­com­pen­sated care de­liv­ered at pub­lic hospi­tals. The se­cond, due June 1, 2017, will fo­cus on un­com­pen­sated care, provider pay­ments and fi­nanc­ing.

Cal­i­for­nia is among nine states with fed­er­ally funded un­com­pen­sated-care pools. Last year, the pools were the sub­ject of a pub­lic feud be­tween the Obama ad­min­is­tra­tion and Florida Gov. Rick Scott and Texas Gov. Greg Ab­bott, who ac­cused the ad­min­is­tra­tion of hold­ing the fund­ing hostage to force the states to ex­pand Med­i­caid.

The CMS re­buffed that in­ter­pre­ta­tion, but the ad­min­is­tra­tion did ques­tion why the fed­eral govern­ment should sub­si­dize care for unin­sured Amer­i­cans who would be cov­ered if their states ex­panded Med­i­caid el­i­gi­bil­ity.

The agency echoed that po­si­tion in a let­ter to Cal­i­for­nia’s Med­i­caid di­rec­tor, ex­plain­ing that the in­de­pen­dent anal­y­sis of the safety net pool should as­sess why some Cal­i­for­ni­ans re­main unin­sured. “Cov­er­age is the best way to en­sure ben­e­fi­ciary ac­cess to health­care for low-in­come in­di­vid­u­als, and un­com­pen­sated-care pool fund­ing should not pay for costs that would oth­er­wise be cov­ered in a Med­i­caid ex­pan­sion,” CMS Med­i­caid Di­rec­tor Vikki Wachino wrote last fall.

CMS Med­i­caid Di­rec­tor Vikki Wachino.

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