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to make contributions to their own POWER accounts. The contributions are made in the form of monthly premium payments.

Nationwide, HSAs still have low penetration, and there is no research to show how well the model works for a low-income population such as Medicaid families.

Current Status in California

Penetration of HDHPs in the private market is lower in California than nationally.  Just 4 percent of workers in employer-sponsored plans are enrolled in HDHP plans compared to an average of 8 percent nationally.15  Today, Medi-Cal uses the traditional benefit package structure, with very low cost sharing and no deductibles for coverage.

Change Options

California could introduce HOA plans for a childless adult expansion population, limiting the per-member-per-month costs of the coverage expansion.  Alternatively, the state could introduce HOA plans for existing populations, such as children, creating savings for other reforms under the waiver.  However, those cost savings may be small given the limitations in the Medicaid HOA program which exclude the highest-cost populations and cap cost sharing.

15 California HealthCare Foundation, “California Employer Health Benefits Survey,

Health Management Associates/Harbage ConsultingPage 29

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