DHCS Medi-Cal Waiver Update

The Department of Health Care Services (DHCS) announced changes to the Special Terms and Conditions of California’s Section 1115 ‘Medi-Cal 2020’ Waiver.

The Centers for Medicare & Medicaid Services (CMS) approved two amendments requested by DHCS. The first, authorizes DHCS to include Federally Recognized Tribes and Tribal Health Programs as lead entities for the Whole Person Care (WPC) pilots. The second, allows DHCS to modify the payment methodology for Domain 1 of the Dental Transformation Initiative (DTI), which targets increases in preventive dental services for California children. The amendments are effective as of December 8, 2016.

The approved amendments will be posted to the Medi-Cal 2020 website. Additional information is available on the WPC webpage and the DTI webpage.

DHCS also submitted an amendment to add the Medi-Cal Access Program (MCAP) population to the Medi-Cal Managed Care delivery system. MCAP – a program DHCS inherited from the Managed Risk Medical Insurance Board – provides low-cost health insurance coverage to uninsured pregnant women with incomes at 213%-322% of the Federal Poverty Level. If approved, all new MCAP enrollees would be enrolled starting July 1, 2017 into a Medi-Cal managed care plan operating in their county of residence. To minimize care disruption, women enrolled into MCAP prior to July 1, 2017 will continue to receive care under the Medi-Cal Fee-for-Service delivery system.

Additional information related to MCAP is available on the MCAP website Questions or comments can be directed to: 1115Waiver@dhcs.ca.gov.