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Medicaid, SCHIP, & Federal Authority

  • 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.

High-Risk Pools

  • The California Major Risk Medical Insurance Program (MRMIP) was a program developed to provide health insurance for Californians who are unable to obtain coverage in the individual insurance market. This program became operational in 1991. Subscribers in the MRMIP are charged a monthly premium ranging from 125 to 137.5 percent of each participating plan's average standard individual rate. On May 21, 2008 the enrollment cap was lowered to 7,100 from 8,101. Due to limited state appropriation, MRMIP enrollment is currently closed and there is a waiting list for new enrollments.

Group Purchasing Arrangements

State Specific Strategies

  • Access for Infants and Mothers (AIM) program - This state-funded program was established in 1992. AIM offers low-cost health coverage for pregnant women and their newborns. It has been designed for middle-income families who don’t have health insurance and whose income is too high to qualify for no-cost Medi-Cal. AIM is also available to those who have health insurance if their deductible or co-payment for maternity services is more than $500. This program provides coverage for those between 200 and 300 percent FPL. In 2004, the state began enrolling infants born of AIM enrollees into the Healthy Families Program, California’s SCHIP program. California now draws Title XXI (SCHIP) funds to cover pregnant women between 200 and 300 percent FPL. 

    Children’s Health Initiatives – Over twenty counties operate Children’s Health Initiative programs but unstable funding has lead to waiting lists and questions on future sustainability. These county-level programs have been quite successful in enrolling children and families into the Medi-Cal and Healthy Families Program. In 2003, the state expanded health insurance coverage levels to 300 percent FPL for children residing in selected counties – Alameda, San Francisco, San Mateo, and Santa Clara. Three of these counties have drawn federal matching funds for uninsured children to 300 percent FPL via the County Children’s Health Insurance Program (C-CHIP). Currently, San Mateo County serves uninsured children up to 400 percent FPL using county funds. Alameda County chose not to participate in the C-CHIP and has not drawn federal matching funds. 
    County Medical Services ProgramThe County Medical Services Program (CMSP) was established in January 1983, when California law transferred responsibility for providing health care services to indigent adults from the State of California to California counties. Thirty-four counties participate. CMSP provides medical assistance to adults (age 21-64) below 200 percent FPL who do not qualify for Medi-Cal. Other resource limits apply.