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cancer at higher income levels.   Further, the Healthy Families program, the Access for Infants and Mothers (AIM), and the Family PACT program (funded under a separate Medicaid Section 1115 waiver) provide coverage at higher levels for men and women seeking family planning services.    

California’s current Section 1115 waiver provides federal matching funds for a number of programs serving childless adults who do not pass the federal disability test. The funded programs are associated with a number of previously state-only programs and services provided at designated public hospitals and clinics.  Furthermore, the ten coverage initiatives enroll childless adults in coverage programs where they receive enhanced services including a medical home.

In California there is no federal coverage for county indigent programs that are not associated with a public hospital or the coverage initiative.   

Change Options

A Section 1115 waiver can be used to expand coverage for childless adults who are not otherwise categorically eligible for Medicaid.  It would be very difficult to use this waiver to cover children who are only eligible for limited scope benefits due to their immigration status.   The waiver would not be used for expanding income levels for children already eligible for Healthy Families.  

The federal government has been flexible in how coverage for childless adults is provided and what benefits are provided.  The state has significant flexibility in designing this program and benefits.  This could include:

Direct Medi-Cal Expansion.  The state could expand eligibility through the existing Medicaid program, and provide childless adults either the same benefit package as existing beneficiaries, or a more limited package.

Privately Managed Coverage. The state could provide services using a private vendor who would manage all services in similar fashion to the existing County Medical Services Program (CMSP), which provides benefits to medically indigent childless adults in the 32 smaller counties.  

County-level Coverage Expansion.  The new Section 1115 waiver could expand the number of childless adults the existing ten coverage initiatives can serve and/or expand the number of coverage initiatives to provide coverage in more counties.  An alternative would be to structure a county program for coverage in another manner, such as providing funding and allowing counties to opt into the program.  The coverage does not have to be statewide; however, having differing programs between counties could lead to people moving between counties to obtain better health care coverage.   

Health Management Associates/Harbage ConsultingPage 12

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