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The California Health and Human Services Agency
(CHHS) has announced plans to seek a federal 1115 Medicaid Demonstration
Waiver to redesign the Medi-Cal program. Medi-Cal is California's
version of the federal Medicaid program, the health insurance program
for low-income and vulnerable populations. Medi-Cal provides health
insurance to 6.4 million Californians--1 in 6 people in the state--including
more than 3 million children.
Historically, states have pursued waivers to test
out strategies for expanding coverage. However, in recent years,
states have increasingly sought 1115 waivers to reduce state spending
by making changes to their Medicaid programs for current beneficiaries
and by using Medicaid or SCHIP funds to refinance existing coverage.
This appears to be the main impetus behind the Schwarzenegger Administration's
Medi-Cal redesign proposal--a project that the Administration estimates
will save $400 million in FY 2005-06.
Restructuring some aspects of the Medi-Cal program
merits serious consideration. Done correctly, through a thoughtful
process that includes the legislature and other stakeholders, restructuring
could increase access to care, improve quality of care, increase
efficiency, and bring more federal monies into the state. However,
Medi-Cal restructuring should not be a back door to instituting
cuts, particularly if these cuts cost California more in the long
run -- for example by increasing the numbers of uninsured. Medi-Cal
restructuring must proceed from an examination of what the program
does right, and then focus on areas for improvement and increased
efficiency.
For more information, please download the complete
PDF.
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