Dive Brief:
- In what California officials are calling a "conceptual agreement," the state and the federal government have agreed on a $6.2 billion deal to reform the Medicaid program and help fund care for low-income residents. Close to $3.3 billion will be used to improve the safety and quality of patient care at public hospitals.
- Known as the "Medi-Cal 2020" waiver, the new plan also provides funds to cover the uninsured and create pilot programs to keep high-need populations out of EDs. Specifics of the agreement will continue to be worked out.
- The new waiver changes the way government covers the uninsured: Instead of only covering hospital-based care, public hospitals and clinics will have greater flexibility to focus more on outpatient and primary care. However, the plan only specifies $236 million for the first year to cover uninsured Californians, with funding for the remaining four years to be based on outside assessment of how much hospitals need.
Dive Insight:
Although the deal provides less than what the state originally requested ($17 billion), Erica Murray, CEO of the California Association of Public Hospitals and Health Systems, said it includes all the key policies needed to help public hospitals continue their work started under the previous waiver agreement, reported Kaiser Health News.
The expiring five-year waiver, "Bridge to Reform," enabled hospitals to begin to change how they provided care. Examples include programs to track patients with chronic diseases and expand primary care clinics, as well as programs to reduce deaths by sepsis infections and uncontrolled diabetes.
Anthony Wright, executive director of Health Access California, said in a statement, "We expect to see an explosion of exciting activity at the county level to improve healthcare."
It's estimated more than 3 million Californians are still uninsured, despite the expanded coverage from the Affordable Care Act, according to Kaiser Health News.