1. Section 1115 Medicaid Waiver Renewal Workforce Development Expert Stakeholder Workgroup Framing Our Discussion Anastasia Dodson Department of Health Care Services November 20, 2014

2. Section 1115 Medicaid Waivers  Allow states flexibility to design demonstration projects that promote the objectives of the Medicaid program  Typically approved for 5 years; States may submit request for waiver renewal for 3 -5 years  Must be budget neutral Integrity Service Accountability Innovation 2

3. CA BTR Waiver California’s Bridge to Reform Waiver (2010-2015)  Current Waiver sunsets on October 31, 2015  Waiver renewal request must be submitted to the Centers for Medicare and Medicaid Services (CMS) at least 6 months before the end of the current waiver Integrity Service Accountability Innovation 3

4. 2015 Waiver Renewal Initial Concepts Integrity Service Accountability Innovation 4

5. Purpose of Section 1115 Medicaid Waiver Renewal To further delivery of high quality and cost efficient care for our beneficiaries To ensure long-term viability of the delivery system post-ACA expansion To continue California’s momentum and successes in innovation achieved under the “Bridge to Reform” Waiver Shared Goals with CMS Integrity Service Accountability Innovation 5

6. Objectives Strengthen primary care delivery and access Avoid unnecessary institutionalization and services by building the foundation for an integrated health care delivery system that incentivizes quality and efficiency Address social determinants of health Use California’s sophisticated Medicaid program as an incubator to test innovative approaches to whole-person care Integrity Service Accountability Innovation 6

7. Waiver Concepts Initial Waiver Concepts Federal/ State Shared Savings Payment/ Delivery Reform Incentive Payments Safety Net Payment Reforms FQHC Payment/ Delivery Reform Successor DSRIP CCS Program Redesign Shelter for Vulnerable Populations Workforce Development Integrity Service Accountability Innovation 7

8. Plan / Provider Incentives Workforce Development Goal 1 : Increase number of health workers to provide health care services in medically underserved areas or to serve a high number of Medicaid beneficiaries Goal 2: Develop innovative ways to address whole person care to meet the unique yet interrelated needs of physical and mental health Goal 3: Create financial and other incentives to encourage greater commitment to serve Medicaid beneficiaries and practice in underserved areas Integrity Service Accountability Innovation 8

9. Goal1 : Increase the number of health workers to provide health care services in medically underserved areas or to serve a high number of Medicaid beneficiaries Attract new health professionals to provide health care services in medically underserved areas and/or to serve a high number of Medicaid beneficiaries Increase retention to stabilize a health care workforce to meet the specific needs of the community Medicaid beneficiaries. Address scope of practice limitations to increase pool of available health workforce and allow existing professionals to practices at top of scope Support ability of health professionals to work with greater efficiency 1a Integrity Service Accountability Innovation 9 1b 1c 1d

10. Develop innovative ways to address whole person care to meet the unique yet interrelated needs of physical and mental health Create financial and other incentives to encourage greater commitment to serve Medicaid beneficiaries and practice in underserved areas Integrity Service Accountability Innovation 10 Goal 2 Goal 3

11. Criteria for Consideration Addresses Workforce Goals Fits shared CMS 1115 Waiver Renewal Goals – To further delivery of high quality and cost efficient care for our beneficiaries – To ensure long-term viability of the delivery system post-ACA expansion – To continue California’s momentum and successes in innovation achieved under the “Bridge to Reform” Waiver Feasible – Medicaid laws and regulations and CMS financial participation requirements – State law – Stakeholder support Measurable for Evaluation 11

12. Questions / Comments: WaiverRenewal@dhcs.ca.gov WaiverRenewal@dhcs.ca.gov Integrity Service Accountability Innovation 12