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Financing

Modeling Cost-Sharing Options in Medi-Cal Redesign

PricewaterhouseCoopers

July 2005

In January 2004, Governor Schwarzenegger announced plans to restructure the Medi-Cal program. Under the governor's proposal, covered benefits and cost-sharing requirements would vary among program participants.

With funding from the California HealthCare Foundation and The California Endowment, PricewaterhouseCoopers developed a model to estimate the change in aggregate Medi-Cal enrollment, service use, and expenditures that would result from changes to cost-sharing requirements and benefit design.

The Medi-Cal Cost Sharing Financial Model can examine up to five benefit designs at one time, including those with no copayments or premiums. The model also goes beyond many other estimation models by incorporating assumptions regarding both the direct and indirect impact of premiums and copayments on demand for services.

The model was developed based on benefit design and cost-sharing options discussed by the California Department of Health Services at a meeting of the Medi-Cal Redesign Benefits and Cost Sharing Workgroup held in the spring of 2004. The final model, completed in December 2004, reflects extensive feedback from the technical advisory group created for this project.

The technical report and user guide, available below, contains a complete description of the model. Also provided are a presentation prepared for a January 2005 legislative briefing in Sacramento that includes estimates of the impact of the governor’s proposal for Medi-Cal cost sharing, as well as a memorandum containing answers to questions raised during the briefing.

Document Downloads

Medi-Cal Cost-Sharing Model: Legislative Briefing (2.069MB)

Medi-Cal Cost-Sharing Model: Technical Report and User Guide (1.602MB)

Medi-Cal Cost-Sharing Model: Responses to Briefing Questions (125K)

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