The Centers for Medicare and Medicaid Services (CMS) has approved a new section 1115 Medicaid demonstration for the state of California. Under the demonstration, the California Department of Health Care Services (DHCS) will develop and redesign components of its Medicaid delivery system consistent with the approved terms and conditions, creating significant changes to California’s Medicaid program, entitled Medi-Cal. The new demonstration, entitled “Medi-Cal 2020,” is authorized for a five-year period from January 1, 2016 through December 31, 2020.
The Medi-Cal 2020 terms and conditions reflect policy goals that were agreed to between the state of California and CMS following months of negotiation, including a goal of transforming the Medicaid delivery system to promote sustainable, value-based models of care. These priorities and the programs developed are likely to serve as models for other states. Medi-Cal 2020 also continues a history of innovation in California’s Medicaid program. Under its previous “Bridge to Reform” Medicaid demonstration, California was among the first states in the country to extend Medicaid program benefits to low-income adults under the authority of the Affordable Care Act through county-led Low Income Health Programs (LIHPs), and implemented the country’s first delivery system reform and incentive pool (DSRIP).
Some of the new initiatives authorized by the Medi-Cal 2020 demonstration are summarized below.
DHCS, CMS, and stakeholders continue to work to finalize details of these programs so that they may be implemented. The demonstration also continues previously approved programs, including the operation of California’s Medicaid managed care systems, Drug Medi-Cal Organized Delivery System, the Coordinated Care Initiative (including Cal Medi-Connect) that integrates care for Medicaid and Medicare beneficiaries, and the state’s Community-Based Adult Services program.