The CMS has signed off on California's Medicaid waiver, along with its decision to renew extra funding that supports the state's public safety net hospitals for only one year instead of five.
As part of the waiver, the state will receive $6.2 billion to sustain efforts to reform its Medicaid program under a massive transformation waiver that expired on Oct. 31.
The new waiver also includes $3.3 billion to help public safety net hospitals launch and maintain delivery-system reforms, including infrastructure development, system redesign, and improvements targeting clinical outcomes and population health. The funding to help those hospitals shoulder the burden of uncompensated care was renewed for only one year instead of five like the other provisions.
After the first year, the CMS will reconsider funding levels based on two reports. The first report, due May 15, will focus on uncompensated care delivered at public hospitals. The second, due June 1, 2017, will focus on uncompensated care, provider payments and financing.
California is among nine states with federally funded uncompensated-care pools. Last year, the pools were the subject of a public feud between the Obama administration and Florida Gov. Rick Scott and Texas Gov. Greg Abbott, who accused the administration of holding the funding hostage to force the states to expand Medicaid.
The CMS rebuffed that interpretation, but the administration did question why the federal government should subsidize care for uninsured Americans who would be covered if their states expanded Medicaid eligibility.
The agency echoed that position in a letter to California's Medicaid director, explaining that the independent analysis of the safety net pool should assess why some Californians remain uninsured. “Coverage is the best way to ensure beneficiary access to healthcare for low-income individuals, and uncompensated-care pool funding should not pay for costs that would otherwise be covered in a Medicaid expansion,” CMS Medicaid Director Vikki Wachino wrote last fall.