Medi-Cal 2020: One Year Later

By Lucy Pagel
Policy Consultant

Approved at the end of 2015, California’s Medicaid section 1115 waiver renewal, known as Medi-Cal 2020 is now well underway. The waiver has many components, but the Department of Health Care Services (DHCS) was particularly active in three areas during 2016:  1) The Public Hospital redesign and Incentives in Medi-Cal (PRIME) Program (formerly known as DSRIP), 2) The Whole Person Care (WPC) pilot program, and 3) The Drug Medi-Cal Organized Delivery System (DMC-ODS). Harbage Consulting was proud to provide policy and operational support to the state on each of these initiatives. Following are some highlights:

Public Hospital Redesign and Incentives in Medi-Cal (PRIME)
Fifty-four of California’s safety-net hospitals are participating in PRIME, more than double the number of hospitals that were involved in DSRIP. The goal of the $7.4 billion program is to improve how the state’s safety-net hospitals deliver care while also maximizing health care value and moving toward alternative payment models (APMs) in Medi-Cal. For more information, see our new fact sheet – The Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program: Continuing California’s Delivery System Transformation.

Whole Person Care Pilots
The WPC pilot program seeks to coordinate health, behavioral health, and social services to improve the health of Medi-Cal beneficiaries who are high utilizers of the health care system. Through collaboration and coordination among county agencies, health plans, providers and other entities, these pilots are designing and developing the needed infrastructure and processes to integrate and improve care for vulnerable populations.

DHCS approved 18 WPC pilot applications in November 2016. The state did not allocate all of the available funding in the first round, so DHCS will open up applications for a second round of pilots in 2017. Stay tuned for updates!

Drug Medi-Cal Organized Delivery System
The DMC-ODS is a pilot program that offers California counties the opportunity to expand access to high-quality care for Medi-Cal enrollees with substance use disorders (SUD) through creation of an organized delivery system. DMC-ODS offers beneficiaries expanded benefits and improves access to care by:

  • Expanding local networks of high quality providers through selective provider contracting;
  • Requiring the use evidence-based practices in SUD treatment;
  • Increasing coordination with other systems of care, including physical and mental health; and
  • Increasing local control and accountability with greater administrative oversight.

So far, 18 counties have submitted implementation plans to participate in the DMC-ODS and San Mateo County has been approved to begin implementation. The remaining 17 plans are currently under DHCS and CMS review.