Renewing the Bridge to Reform (Section 1115 Waiver)

by Samantha Beasley, Health Care Policy Manager, L.A. Area Chamber

At our last Health Care Council Meeting, we had a great discussion on issues to include in our 2015 advocacy agenda. In this, California’s section 1115 “Bridge to Reform” Waiver arose. Set to expire in October of 2015, the current 5-year demonstration waiver provides initiatives to invest in the state’s health care delivery system to tackle the significant changes spurred on by the Affordable Care Act (ACA).

Over the past several years, the Bridge to Reform Waiver has been used to enroll 650,000 individuals in an early expansion of the ACA provision working to expand Medicaid eligibility to more adults in poverty. Additionally, by incorporating existing Medi-Cal managed care reforms into the Bridge to Reform Waiver, as well as expanding managed care to seniors and persons with disabilities (SPD), federal savings have increased and have been used to fund new Medi-Cal and related costs. These include the Low-Income Health Program (LIHP), Delivery System Reform Incentive Pool (DSRIP), the Coordinated Care Initiative (CalDuals), and state programs for the uninsured.

California hopes to build off the success of the current Bridge to Reform Waiver through a renewal that will continue to fund improvements in the Medi-Cal delivery and payment system. In this, the state would have the support and resources to pursue objectives beyond the ACA’s primary step of coverage expansion to overall improvements in the health care system, including expanding access, improving care quality and outcomes, controlling the cost of care, and ensuring ongoing safety net support.

Additionally, California hopes to invest in areas that may indirectly affect healthcare costs. These include Medicaid funded homes and/or shelter for vulnerable populations (such as those with behavioral health problems), improvements in California Children’s Services (CCS), potentially through “pay for performance” programs, and workforce development.

The waiver renewal finds many supporters including the California Hospital Association (CHA), the California Association of Public Hospitals and Health Systems (CAPH) and the Office of the President of University of California. Additionally, the California Department of Health Care Services (DHCS) is holding stakeholder workgroups in Sacramento to gather community input before the waiver renewal application is submitted in February of 2015. In this, each meeting is focused on a specific component of the waiver proposal including the DSRIP, housing/shelter, safety net financing and workforce development. For each topic there is one workgroup per month through Feb. 3, 2015. The meetings can be heard and public comment can be made through the DHCS website - http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx.

For more information on the Section 1115 Bridge to Reform Efforts, please find the links below:

Initial concepts of Waiver renewal

http://www.dhcs.ca.gov/provgovpart/Documents/Waiver%20Renewal/Initial_Concepts_for_2015_Waiver-July_2014.pdf

Midpoint analysis on 2010 Bridge to Reform Waiver

http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/B/PDF%20BridgeToReform1115Waiver.pdf

Overview of proposed components in Waiver renewal

http://www.dhcs.ca.gov/provgovpart/Documents/Waiver%20Renewal/WaiverRenewalWebinar072514.pdf

Input letters and suggestions from supporters of Waiver renewal

http://www.dhcs.ca.gov/provgovpart/Pages/Stakeholder-Input-Letters.aspx

Expert stakeholder workgroup meetings—list of dates, times, locations, and topics

http://www.dhcs.ca.gov/provgovpart/Documents/Waiver%20Renewal/Workgroup_Dates_and_Locations11_10_14.pdf

List of members on DHCS stakeholder advisory committee

http://www.dhcs.ca.gov/Documents/SAC2014members.pdf