Access to Medi-Cal Waiver Programs - Essay Example

? Medi-Cal Waiver Medi-Cal Waiver Medi-Cal refers to a Medicaid program in the of California, United s of America. Medi-Cal waivers in return are the programs under Medi-Cal which provide additional services to particular groups of individuals, low income Californians in particular, as well as pay for others with very high medical expenses. These waivers are often used as a tool by the Californian policymakers to induce changes in the health care system of California. Whenever California aims to make considerable changes to its Medicaid program, it either ameliorates its State Medicaid Plan or receives a Medicaid waiver by the U.S. Department of Health and Human Services. However, it is ensured that they are given to truly deserving and eligible people (California Department of Health Care Services: What are Medi-Cal Waivers, 2012). The access to Medi-Cal waiver programs involves a few steps. The very first step is to establish Medi-Cal eligibility. The applications can be acquired from any local or nearest county social services offices. If the person encounters any difficulty while filling out the application, a mere call to the county social services agency can solve the problem instantly. Other options include mailing or simply taking the application with the required proof or verification to any nearly located social services agency. These services are directed towards specific groups and populations based purely on need. The general public is mostly acquainted with the services through the official website of the California Department of Health Care. It plays a major role in assisting the masses with the entire process of access to the waiver programs. For some waiver services, the process is as simple as contacting the nearby county social services office in the country, However, for other special services, eligibility must be determined by a thorough assessment coordinated through the program administrator. The eligibility criterion and everything related to it is updated on the website and if a person identifies some waiver services that might be of support to him, a friend or even a family member, a simple click displays all the eligibility requirements as well as the necessary contact information (California Department of Health Care Services: How to Access Medi-Cal Waiver Services, 2012). California Department of Health Care services administers a large number of Medi-cal waiver programs that provide various services including home or community-based services, mental health services, family planning services etc. The special service provided by the Department of Health Care comprises of managed care to particular groups of eligible individuals. The list of a few current waivers consist of “Acquired Immune Deficiency syndrome (AIDS) waiver, Assisted Living Waiver (ALW), Home and Community-based services waiver for the developmentally disabled (HCBS-DD), Family planning, Access, Care and Treatment Program (Family PACT), In Home Operations (IHO), Developmentally Disabled- Continuous Nursing Care (DD-CNC), Multipurpose Senior services program (MSSP), Nursing Facility, Acute Hospital (NF/AH), Specialty Mental Health Consolidation Program (SMHC) and Pediatric Palliative Care Waiver (PPC)”, while “San Francisco Community Living Support Benefit Waiver and Self- Directed Services Waiver for Individuals with Developmental Disabilities” are still under development and expected to be launched soon. In addition to the above mentioned services, a few other waiver services were also in practice in the past that ended later on or have been modified with the passage of time. These include In-Home Medical Care, Los Angeles County Section 1115 Medicaid Waiver Demonstration Project, Nursing Facility A/B, Nursing Facility Subacute and In- Home Supportive Services Plus (California Department of Health Care Services: List of Medi-Cal Waivers, 2012). There are basically two types of Waivers. 1915 (b) and 1915 (c) are known as program waivers and they relate to the managed care and home or community based care. 1115 waivers, on the other hand, are referred to as Research and demonstration waivers that allow experimentation or testing of a program. Out of California’s five million receivers of Medi-Cal, approximately two million have been enrolled in various programs under one of the California’s 1915(b) waivers. Moreover, Medi-Cal’s mental health systems function under 1915 (b) waivers as well. The financing and organization of inpatient and outpatient health services were consolidated by these mental health waivers. Research and Demonstration Waivers or 1115 waivers provide much more immunity from a wider-set of Medicaid regulations than the ones provided by 1915 waivers. For medically impoverished females with incomes between 100% and 200% of the federal poverty level, the family planning waiver has recently been approved. This waiver wraps up reproductive health services for poverty-stricken women in particular. It was initially a part of the Governor Diva’s 1999-2000 budget. The funds for family planning waiver services are matched at approximately 90% by the federal government as compared to the 51% for other services (Lewis and Medi-Cal Policy Institute, 2000) There are three most important goals around which the recent policy debates in California have been focused. These goals for which these waivers can be used include the production of savings, increase in eligibility and meeting long term care needs of the Californian people. They deal with the various important questions regarding Medi-Cal and the particular direction the government of the state itself intends to take the Medi-Cal program. The most important of them address the impacts of an increase in Medi-cal’s reimbursement rates, indirect subsidization of further indigent care, trade-offs of using 1115 waivers to broaden eligibility rather than the options available in 1032 (b) program, the effect on the state additional flexibility in designing program changes under 1115 waiver, cost-sharing for new-eligibles, appropriate level of premiums and permanent solutions for the eligibility expansions in order to ensure the coverage of affected populations. However, these Medicaid waivers should not be considered entirely magical in solving the health issues in California but, on the other hand, they definitely play a significant role in terms of imperative tools for meeting the policy goals such as increased coverage of the uninsured, maximization of the revenues and scheming growth (Lewis and Medi-Cal Policy Institute, 2000). California’s Medi-Cal grew and developed so much that it required almost one-sixth of the total State Budget. This expansion endangered other programs of the state including Welfare, Education, environmental protection etc. It raised much hue and cry in certain sections of the community and the ambiguous and one-sided misleading comments on California’s Medi-cal Copayment Experiment raised suspicions among the people. California’s Medi-cal Copayment Experiment required about 30 percent of the eligible Medi-cal recipients to pay a dollar for each of their first two visits to physicians, providers etc. each month and 50 cents for each of the first two prescriptions. However, it was made essential for only those people who had some resources or property above a defined level. Therefore, The Medi-Cal reform Act of 1971 was enacted by a 56-13 vote in Assembly and a 28-11 vote in the State Senate. It was considered an expression of the will of the people through their representatives in the State Senate and assembly resulting in the significant changes in the Medi-Cal programs (Brian, 1975). The probable next steps for the policymakers of California include the comparison between the current and past waivers by evaluating their effectiveness, examination of the unintentional results of California’s Waivers, development of inventive uses for the new waivers, improvement in the collaboration process between the state and the counties to assist the development of new waiver programs and gaining knowledge from the past experiences of the other state’s waiver programs. Although, all these steps and possible policies require extensive research and public debates among Californians, California’s federal state and the county policymakers (Lewis and Medi-Cal Policy Institute, 2000). References Brian, Earl. (1975). Medi-Cal Criticisms in Perspectives. Medical Care, 13, 4, 360-364. California Department of Health Care Services. (2012). How to Access Medi-Cal Waiver Services.. State of California. Retrieved from http://www.dhcs.ca.gov/services/medi-cal/Pages/AccessMedi-calWaivers.aspx California Department of Health Care Services. (2012). List of Medi-Cal Waivers. State of California. Retrieved from http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalWaiversList.aspx California Department of Health Care Services. (2012). What are Medical Waivers. State of California. Retrieved from http://www.dhcs.ca.gov/services/medi-cal/pages/medicalwaivers.aspx Lewis, V., & Medi-Cal Policy Institute. (2000). Medicaid waivers: California's use of a federal option. Oakland, CA: Medi-Cal Policy Institute. Read More