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DHCS releases Medi-Cal concept paper that proposes risk-based health home models and malpractice subsidies

September 02, 2014


The California Department of Health Care Services (DHCS) has released a proposal in the form of a concept paper for the state’s next 1115 Section Medicaid Waiver for public for comment.

California is currently in the fourth year of its current Section 1115 waiver that was approved by the federal government so California could expand Medi-Cal coverage in accordance with the Affordable Care Act in 2010 and implement a variety of delivery reform projects like the duals demonstration project.

The concept paper outlines new ideas to modify provider payments and save money in the Medicaid system. Major concepts within the paper include a shared federal and state savings initiative that would establish capitated per beneficiary payments for the various beneficiary categories, payment reform through accountable care-like programs or risk-based delegated health home models, and the subsidization of malpractice insurance premiums for physicians whose practices serve a significant percentage of low income patients. The waiver, if approved, will be implemented in November 2015 and run for five years.

The California Medical Association is currently reviewing the proposal in detail and will provide written and verbal comments after discussion with the association's Medi-Cal Technical Advisory Committee.

Contact: Lishaun Francis, (916) 551-2554 or lfrancis@cmadocs.org.

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