California Medicaid and SCHIP Waivers

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Section 1115 Waiver – In 2005, California received approval for its Medi-Cal Hospital Uninsured Care 1115 Waiver, allowing the state to continue its Selective Provider Contracting Program (SPCP) with a limited number of hospitals at a prospective per diem rate lower than the standard rate paid in the absence of the waiver.[1] In return, the selected hospitals receive preferential or exclusive referrals of Medicaid patients in their geographic areas. The demonstration also created a Safety Net Care Pool (SNCP), with $766 million in Federal funds annually to assist providers with unreimbursed costs incurred in serving uninsured patients. For October 2007 through August 2010, $180 million of the annual Safety Net Pool allocation is diverted to expand coverage to uninsured individuals through the demonstration’s Healthcare Coverage Initiative. The State selected ten counties to cover an estimated 180,000 eligible low-income, uninsured adults ages 19-64 through this comprehensive healthcare coverage initiative. Cost sharing may be required and is based on income level. The ten counties will test innovative ways of providing health services while increasing the number of Californians with coverage, strengthening the local health care safety net system, and improving access to high-quality health care and health outcomes.   

[1]Prior to the section 1115 approval, California implemented SPCP under 1915(b) authority.