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Table of Contents

Page Number:

Introduction 4

Waiver Background7

1.  Eligibility Reform Option11

2.  Service Delivery Reform Options

A. Restructuring Delivery Systems into Population-Based Collaborative Networks 13

B. Restructuring the Medi-Cal Fee-for-service Program and Providing a Medical Home15

C. Payment System Reforms to Encourage Ambulatory Not Inpatient Care18

D. Strengthening and Transforming the California Children’s Services Program 19

E. Management of Dual Eligibles 22

3.  Health Savings Account Reform Option28

4. Quality Improvement Reform Options

A. Improvements to Care and Reductions in Cost: Medi-Cal Beneficiaries30

B. Improvements to Care and Reductions in Cost: Non-Medi-Cal Beneficiaries 33

C. Ways to Reduce Medical Error, Never Events, and Readmissions 34

5. Infrastructure Reform Options

A. Address Workforce Shortages38

B. Health Information Technology40

C. E-Prescribing42

6. Financing Options

A. Financing Arrangements44 B. Financing Charts52

7. Comparison to Other State WaiversSeparate Attachment

8. Appendix – List of Acronyms58

Health Management Associates/Harbage ConsultingPage 3

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