Under the recently approved 1115 Waiver, Los Angeles County will launch its Low Income Health Program, called Healthy Way LA. This program, which is part of Medicaid expansion, is meant to provide insurance coverage to adults at 0-133 percent of the Federal Poverty Level. 

There is no enrollment cap and the ultimate goal is to enroll all eligible Los Angeles County residents.

The reimbursement rate for the program remains at 50 percent, but revenue will now come from outside budget neutrality.

The initial phase of Healthy Way LA is to enroll existing DHS/Community Partners (formerly called PPP) patients (150,000 potentially eligible), including:

• DHS/PPP patients on General Relief (50,000+)
• Patients using both DHS and DMH services (8,000)

The next enrollment wave will target homeless, General Relief and DMH high utilizers not currently using DHS/PPP.

The Healthy Way LA service network will include all DHS and community partner sites as well as hospitals that include Antelope Valley Hospital and UCLA. The County will provide transportation to Healthy Way LA members who reside in the San Gabriel Valley who need to visit LAC+USC Medical Center. Additional clinic sites may be added via RFSI process (FQHCs and CCEP sites).

Healthy Way LA will reimburse private hospitals for ER and post-stabilization care to members. Prior authorization will be required for admission. Reimbursement will be at 30 percent of regional CMAC rate.

In addition to current benefits, the program will feature:

• Mental health services
• Out-of-network emergency and post-stabilization care
• New access standards
• Initial health assessment
• Non-emergency transportation (with prior authorization)
• Due process standards and procedures

For information on patient eligibility and authorization, hospitals can call (877) 333-4952.