Areas of Focus

The health care environment is shifting all around us. Health system reforms sparked by changes in the Affordable Care Act and California health policy changes are transforming our local health care delivery systems. CCRHI is committed to helping local health collaboratives understand these system redesign opportunities and bring resources to support discussion and planning in your local community.

California §1115 Medi-Cal Waiver

The Bridge to Reform Waiver guided the state’s effort to prepare for implementation of the Affordable Care Act and Expansion of the Medi-Cal Program to thousands of new beneficiaries. California is now working to implement its plan for the Medi-Cal Program over the next five years. On December 30, 2015, the federal Center for Medicare and Medicaid Services (CMS) approved California’s 1115 Waiver Renewal, called Medi-Cal 2020. This waiver includes some significant changes to the health care safety net in California, which may provide opportunities for rural communities. These include:

  • Drug Medi-Cal Organized Delivery System (DMC-ODS)
  • Drug Medi-Cal ODS Tribal Delivery System
  • Whole Person Care Demonstration Pilots

For more information on the Medi-Cal 1115 Waiver, visit Insure The Uninsured Project for in-depth analysis and reports (click to access the external site).

Section 2703 Health Homes for Patients with Complex Needs (HHPCN)

The Medicaid Health Homes State Plan Option, authorized under the ACA, allows states to create Medicaid health homes that coordinate the full range of physical health, behavioral health, and community based services and supports for individuals with complex needs and chronic conditions.

The Health Homes Program will serve eligible Medi-Cal beneficiaries with multiple chronic conditions who are frequent utilizers of health care services. Health homes provide six core services:

  • Comprehensive care management
  • Care coordination between medical, behavioral health, and community-based long term services and supports (LTSS)
  • Health promotion
  • Comprehensive transitional care
  • Individual and family support
  • Referral to community and social support services

Implementation of the program is scheduled to begin in March 2016 with technical assistance to prepare providers and the development of health home networks. The program will be rolled-out in phases beginning in January 2017.

The first group proposed to implement the program include the following counties: Del Norte, Humboldt, Lake, Marin, Mendocino, Napa, San Francisco, Shasta, Solano, Sonoma, and Yolo (Department of Health Care Services, Health Homes for Patients with Complex Needs California Concept Paper Version 3.0; access concept paper).

The second group proposed to implement the program would begin in July 2017 and includes the following counties: Imperial, Lassen, Merced, Monterey, Orange, Riverside, San Bernardino, San Mateo, Santa Clara, Santa Cruz, Siskiyou, and Ventura.

The final phase would begin January 2018 and includes: Alameda, Fresno, Kern, Los Angeles, Sacramento, San Diego and Tulare.