California

Name of Medicaid Program(s) and number of people participating

California’s Medicaid program is called Medi-Cal.  It is administered by the California Department of Health Care Services.  As of June 6, 2018, there were 11,984,671  individuals enrolled in Medi-Cal.1

Expanding Medicaid?

Yes. 

Health Insurance Marketplace (if applicable)/ State based, Partnership or Federally Facilitated Exchange? 

State based marketplace:  Covered California

Health Information Exchange (if applicable)

California has a number of HIEs, but most of them belong to the California Association of Health Information Exchanges.  The California Department of Public Health also has its own Health Information Gateway, which facilitates the exchange of health information among many stakeholders, such as providers, hospitals, laboratories, local health agencies, and the federal government.  

APCD (if applicable) 

California Healthcare Performance Information System (CHPI), which is maintained by the California Healthcare Performance Information System Collaborative. 

Featured Initiatives:

·         Section 1115 Demonstration Project Waiver: Bridge to Reform2 incorporates medical homes into care delivery for Medi-Cal managed care members as well as newly eligible Medi-Cal members under the ACA.  Medical homes are also to be expanded to include Medicare enrollees and dual eligibles.  The project also shifts payments for public safety net hospitals from fee-for-service to global capitated payments, and will implement value based purchasing to incentivize providers to provide more efficient care. 

·         California received almost $2.67 million from the Centers for Medicare and Medicaid Services (CMS) as a State Innovation Model (SIM) grantee.  California’s grant was used primary to explore new payment and service delivery models by building on existing initiatives such as capitated payment models, accountable care organizations, bundled episode payments, the Coordinated care initiative for dual-eligibles, and the Section 1115 Medi-Cal waiver.3

·         Aligning Forces for Quality Name: Aligning Forces Humboldt County.  The Alliance is led by the California Center for Rural Policy and its main aim is to improve quality and provide integrate, patient-centered care that is accessible.  There are three main aims of the project, including 1) provider measurement and public reporting; 2) patient involvement, and medical care improvement activities; and 3) to improve the medical care and self-care of patients.

·         California also has a Chartered Value Exchange (CVE) within the state.  The participating organizations include:  California Cooperative Healthcare Reporting Initiative (CCHRI); Integrated Healthcare Association (IHA), California Hospital Assessment and Reporting Taskforce (CHART), AARP California, California Quality Collaborative (CQC), The California Office of the Patient Advocate (OPA), California HealthCare Foundation (CHCF) 4  Public reporting websites sponsored by the CVE include a California Hospital Compare website as well as a physician and hospital Quality Report Card.5