CMA submits letter to CMS requesting assessment of Medi-Cal rates

March 30, 2015

Last week, the California Medical Association (CMA), along with 17 stakeholder organizations, submitted comments to the Center for Medicare and Medicaid Services (CMS), requesting that an independent assessment of Medi-Cal rates be required as part of the state’s next Section 1115 Medicaid Waiver.

The California Department of Health Care Services (DHCS) is in the last year of its current Section 1115 waiver, which was approved by the federal government so it could expand Medi-Cal coverage in accordance with the Affordable Care Act in 2010. The waiver allowed the state to implement a variety of delivery reform projects, such as the duals demonstration project.

CMA’s letter highlights the broad-based stakeholder support on the subject of Medi-Cal rates – rates that do not come close to covering the cost of care.

The state’s current five-year waiver is set to expire in October 2015. CMA has participated in a number of workgroups designed by DHCS to receive feedback on what new projects the state would implement in the next waiver. The state convened workgroups in order to explore ways to implement incentive payments to providers participating in the Medi-Cal program and how to increase and maintain the physician workforce in the state of California.

DHCS is expected to enter into negotiations with CMS on the new waiver in the spring of 2015, finalizing the waiver’s terms and conditions by fall 2015.



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