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Investing Time and Resources.  Major reform takes time and effort.  Current reform initiatives such as the expansion of managed care, creation of managed care performance standards for seniors and people with disabilities, and implementation of disease and chronic care management have taken longer to implement than anticipated.  The state must be prepared to dedicate additional administrative resources to the implementation of the waiver, given the existing Medi-Cal work load.

The final underlying context for this paper is the unknown structure and nature of national health care reform.  National health reform could fundamentally change California’s responsibilities in the Medicaid program and impact the waiver in any number of ways from requiring coverage expansions for childless adults (and potentially doing so with 100 percent federal funds for eligibility expansions or quality improvements occurring after health care reform is adopted) to requiring maintenance of effort contributions.   

Please note, there is a companion piece to this paper outlining waivers obtained by other states which may serve as a useful reference for policymakers in deciding how to structure a waiver for California.

Health Management Associates/Harbage ConsultingPage 6

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