Title
Receive a presentation from the County's Natividad Medical Center and Health Department staff on Medi-Cal 2020: the five year renewal of California’s Section 1115 Medicaid Waiver.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Receive a presentation from the County's Natividad Medical Center and Health Department staff on Medi-Cal 2020: the five year renewal of California’s Section 1115 Medicaid Waiver.
SUMMARY/DISCUSSION:
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.
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 will continue to provide to California’s Public Safety Net Providers with more than $6.2 billion in federal funding through various programs.
The County is participating in three of the four programs of the 2020 Medi-Cal Waiver: PRIME, Global Payment Program, and Whole Person Care.
Public Hospital Redesign and Incentives in Medi-Cal (PRIME) is a pay-for-performance program in which California’s public health care systems and District and Municipal Hospitals are using evidence-based quality improvement methods to achieve ambitious performance targets and improve health outcomes for patients. All federal funding for this program is contingent on meeting these targets and demonstrating continued improvement.
The Global Payment Program (GPP) is the first payment reform effort aimed at encouraging primary and preventive care. Despite the progress made under the Affordable Care Act, the UC Berkeley Center for Labor Research and Education estimates that by the year 2019, three million Californians will remain uninsured. These individuals have historically had limited access to primary and preventive services, often only seeking emergency health care services when their conditions have become more advanced. In order to earn federal GPP funding, each designated public hospital (DPH) must provide a minimum level of care or “service threshold” - measured in total points accumulated by a (DPH) during a given year. These thresholds are based on historical levels of service provided by each DPH to uninsured individuals.
The Whole Person Care pilot is a five-year pilot program (WPC Pilot) to test locally-based initiatives that will coordinate physical health, behavioral health, and social services for vulnerable Medi-Cal beneficiaries who are high users of multiple systems and continue to have or are at risk of poor health outcomes. Monterey County’s WPC Pilot will be in effect from date of execution of Agreement through June 30, 2021. The initial WPC Pilot focus population is high utilizers of hospital emergency department and inpatient services who are exclusively homeless/chronically homeless Medi-Cal recipients or Medi-Cal eligible persons with no medical health home (including those released from jail) and having three or more of the following characteristics: diagnosed mental illness, four or more mental health unit admissions in the prior year, diagnosed Substance Use Disorder, two or more chronic health diagnoses, three or more emergency department visits within the prior six months, two or more hospital admissions within the prior six months, or five or more significant medications prescribed.
The WPC Pilot features pay for health outcomes, pay for health outcome reporting, and incentive payments for achieving reductions in hospital and mental health unit readmissions, and scheduling prompt medical appointments for Pilot participants (up to 100 annually) who are recently discharged from hospital or released from jail.
The Monterey County Health Department (MCHD) will be the fiscal lead in the WPC Pilot. MCHD and partners will establish a governance structure chaired by the Director of Health, and supported by data, financing, social, clinical, housing, and evaluation workgroups. Appropriate partners will participate in a data sharing agreement that is sufficient in scope for purposes of the WPC Pilot. The WPC Pilot will enable service interoperability, information sharing, and most importantly enable the County to plan, develop, and implement a seamless service delivery system that will have symbiotic benefits. In addition, the County will be able to take longitudinal view of the service delivery system across multiple disciplines of which individually may be successful but may operate in silos.
OTHER AGENCY INVOLVEMENT:
None.
FINANCING:
There is no impact to the General Fund resulting from receipt of this presentation.
Prepared by: Gary R. Gray, DO, Chief Executive Officer, 783-2504
Approved by: Gary R. Gray, DO, Chief Executive Officer, 783-2504
Attachments:
2020 California Waiver Presentation
Attachments on file with the Clerk of the Board