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What Kind of Program Should Medi-Cal Be When It Turns 60?

Christopher Perrone, Director, Improving Access
Chris Perrone
Christopher Perrone

This year marks the 50th anniversary of Medi-Cal. CHCF is celebrating the program's legacy as both a source of health care coverage for millions of low-income Californians and a financial lifeline to safety-net providers. From its early years as a program for people receiving cash welfare assistance, Medi-Cal has been expanded over time to address widening gaps in the private health insurance system.

Anniversaries are not only occasions to reflect upon the past; they are also opportunities to consider the future. As we look ahead, it's clear that maintaining the status quo is not a sustainable option for Medi-Cal. What kind of program do we want Medi-Cal to be when it turns 60? How must Medi-Cal evolve to remain sustainable and effective, and where, collectively, should we begin?

To help answer these questions, CHCF engaged Cindy Mann and her colleagues at the consulting firm Manatt. Cindy is former director of the federal Center for Medicaid and CHIP Services and a thought leader on state Medicaid programs. Her team supplemented their extensive knowledge of Medicaid reforms around the country and federal policy with additional research and interviews of more than 50 leading health care and finance experts in California.

Their thought-provoking findings are summarized in a new report published today. The report provides an overview of Medi-Cal, assesses key challenges and opportunities, establishes a vision for delivery system reform, and articulates a path to achieve that vision. Here are some of my key takeaways from the report:

  • There is broad support for a strengthened Medi-Cal. The high-level vision for Medi-Cal, as expressed in the Medi-Cal 2020 waiver, is "shared accountability among all providers to achieve high-value, high-quality, and whole person care." This vision is shared broadly by stakeholders across California, who emphasize that achieving this vision requires more coordinated systems of care, greater value and accountability, stable and adequate financing, and strong state leadership.
  • We know what important reforms can be acted upon immediately. There are many actions we can get started on now, including reforming how capitation rates are set for Medi-Cal managed care plans, intensifying efforts to coordinate care for people with serious mental illness, and addressing workforce shortages. Many of these reforms are on the state's agenda, and important work is already underway. But much more must be done. As noted in the report, these reforms "will require significant state resources and stakeholder commitment to be implemented successfully."
  • Major structural reforms are needed. Much of Medi-Cal's organization and financing continues to be fragmented, which inhibits the development of accountable systems of care across primary, specialty, behavioral health, inpatient, post-acute, and long-term care. The Medi-Cal 2020 waiver will certainly contribute to positive changes, but it does not tackle the major financing, realignment, and restructuring changes needed to fully achieve the vision for Medi-Cal.

A lot is riding on the choices California makes for Medi-Cal. Medi-Cal now covers one in three Californians, providing a broad array of medical services, as well as long-term care and social supports. The program also plays an integral role in our state's economy. In 2016, Medi-Cal will draw down nearly $60 billion of federal funds into California. A program of Medi-Cal's size and significance must meet our expectations for access to care, quality of care, health outcomes, patient experience, and efficient use of resources. With this new report, we now have a path to get us there.

CHCF will host a briefing in Sacramento on July 13 to discuss the Manatt report findings. All are invited to participate in person or online. Please share your thoughts in the comments below and on Twitter (@CHCFnews) using #MediCal4ward.

About Christopher

Christopher Perrone is director of CHCF's Improving Access team, which works to improve access to coverage and care for low-income Californians.

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