The Los Angeles County Department of Health Services (DHS) provided a status report on its efforts for implementing the 1115 Medicaid Waiver. The Centers for Medicare and Medicaid Services (CMS) approved the California Section 1115 Medicaid Demonstration, titled California’s Bridge to Reform, for a five-year period starting Nov. 1, 2010.

The proposed plan focuses on the following critical elements:

•  Low Income Health Program – Healthy Way LA will provide the framework for the County’s Medicaid Coverage Expansion (0 to 133 % FPL) and cover approximately 130,000 low income adults. Program is expected to start on July 1, 2011.
•  Proposed payment methodology to private providers that will be included in the Waiver program. County is in discussion with three hospitals for services in areas not served by a County hospital.
•  Protocols for annual Delivery System Reform Incentive Payment Pool.
•  Plans to draw down Safety Net Care Pool uncompensated care funds, which includes the South Los Angeles Fund.
•  Partnership with LA Care to move seniors and persons with disabilities (SPDs) into managed care. For now, California Children Services in SPD aid codes will not be mandatorily enrolled.
•   Preparation of workforce to implement the Waiver.
•  Implementation timeline for system and infrastructure developments needed to comply with milestones and expectations established by the Waiver.
•  Integration of health, mental health, and alcohol and substance abuse programs.
•  Timeline and process to identify program sites to pilot the concept of patient-centered behavioral health care homes.

There are currently 427,000 SPD beneficiaries statewide, with 172,000 in Los Angeles County, where it is estimated that about 27,600 current FFS SPD beneficiaries get the majority of their care at county DHS facilities. The County will also seek to enroll an estimated 3,700 SPDs who use community clinics for their primary care, but already seek specialty and inpatient care at a DHS facility.

The Department of Health Care Services will begin outreach to SPDs in March 2011 with mandatory enrollment into managed cared starting in June – rolling 12 month period based on date of birth.