California got a $10 billion Medicaid Waiver. What does that mean?
The so-called "Medi-Cal waiver" is $10 billion in Medi-Cal funds that California secured from the federal government in November 2010.. Funds from the waiver go toward public hospitals and the expansion of local health programs.
According to Anthony Cava -- spokesperson for California's Department of Health Care Services - "the waiver could reduce state spending on health care by as much as $365 million annually".
Previously, seniors and people with disabilities who had Medi-Cal coverage could choose whether to find their own physician or enroll in a managed care plan if one was available in their area. Under the new policy, beneficiaries who live in counties that offer a managed care option will be required to sign up for that plan.
The 16 counties that will be affected by the change are:
- Contra Costa
- Los Angeles
- San Bernardino
- San Diego
- San Francisco
- San Joaquin
- Santa Clara
The shift to managed care will be phased in over the next year. Beneficiaries will need to select a plan by the month of their birthday, or the state will choose a plan for them.
Certain beneficiaries in the 16 counties will be exempt from the requirement, including:
- Children in foster care
- Those who pay part of their Medi-Cal costs
- Those who receive coverage from both Medi-Cal and Medicare
- Those who receive long-term care