CSAC Bulletin Article

CMS Approves California’s Request to Section 1115 Medicaid Waiver Extension

January 7, 2021

Last month, the Centers for Medicare & Medicaid Services (CMS) approved the request from the California Department of Health Care Services (DHCS), for a 12-month extension to the current Section 1115(a) Medicaid Waiver. 

California’s Section 1115(a) Medicaid waiver was scheduled to end December 31, 2020. The waiver has provided investments to address social determinates of health and care coordination for our most vulnerable individuals. California has distinctive county initiatives such as the Whole Person Care Pilots, which coordinate primary care, behavioral health and social services delivering a wide range of wraparound services for California’s Medi-Cal recipients; Public Hospital Redesign and Incentives in Medi-Cal (PRIME); and the Drug Medi-Cal Organized Delivery System (DMC-ODS). Medicaid demonstration waivers have permitted states and local governments to build infrastructure and extend coverage and benefits to individuals most. Throughout 2019 DHCS and stakeholders worked to have California Advancing and Innovating Medi-Cal (CalAIM), replace the current waiver. As a result of the COVID-19, CSAC and county partners requested a delay in the termination of our current waiver and the implementing CalAIM, while the state, counties, and stakeholders focused on addressing the pandemic.

DHCS will submitted the request to CMS in the summer of 2020 to ensure that important programs authorized through Medi-Cal 2020 continue and are eventually transition under CalAIM. CMS approved the Medi-Cal 2020 Section 1115 demonstration, through December 31, 2021. This approval authorizes the Special Terms and Conditions (STCs) of the waiver. CMS and DHCS will work on continued negotiations for specific aspects of programs under the Section 1115 Medicaid waiver.

CSAC will continue to engage with DHCS to ensure the demonstration waivers are utilized to the fullest extent permitted.

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