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Waiver Scope Options for Budget Neutrality

Draft Only

Activity

Justification

Reaction

Pro

Con

CMS

Stakeholders

7

DSH Under the Waiver

Makes funds available for coverage.

Hospitals depend on DSH for such things as making up for uncompensated care loss and low Medi-Cal payment rates.  CA has a low DSH allocation with high uninsured.  

Historically, CMS encourages states to include DSH as part of the waiver.

Patients may exit the public hospital system if they become insured.  DSH is the only federal support for some.

8

Use Safety Net Care Pool to Purchase Coverage

Coverage can be a more efficient means to deliver care than pooled funds.  The Coverage Initiatives funded from the pool do this.

The SNCP has an important and designated role; policymakers maybe concerned about public hospital support.

Most likely viewed favorably.

There will be concern that public hospitals will receive less money and there would be a cost to the GF for state programs.

9

LTC Under the Waiver

By increasing the size of the waiver, a higher growth rate will mean more federal dollars.

Costs are high and difficult to predict.   If the wrong growth rate is used, services could be jeopardized.

CMS should not necessarily have an opinion.  If the population is included, they will likely want reforms related to it.

Providers/advocates may be concerned that the waiver will cap payments.

10

DD Under the Waiver

* By increasing the size of the waiver, a higher growth rate will mean more federal dollars. * DD waiver savings could be fully leveraged.

Costs are high and difficult to predict.   If the wrong growth rate is used, services could be jeopardized.

CMS should not necessarily have an opinion.  If the population is included, they will likely want reforms related to it.

Providers/advocates may be concerned that the waiver will cap payments.

11

Mental Health Under Waiver

* By increasing the size of the waiver, a higher growth rate will mean more federal dollars. * Could lead to better integration of physical and mental health.

Costs are high and difficult to predict.   If the wrong growth rate is used, services could be jeopardized.

CMS should not necessarily have an opinion.  If the population is included, they will likely want reforms related to it.

Providers/advocates may be concerned that the waiver will cap payments.

Health Management Associates/Harbage ConsultingPage 52

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