The Center for Medicare & Medicaid Services (CMS) Expenditure Authority awarded the California Health and Human Services Agency under the State’s title XIX plan. The following expenditure authorities shall enable California to implement the Medi-Cal 2020 Demonstration:
I. Global Payments Program for Public Health Care Systems. Expenditures for payments to eligible Public Health Care Systems, subject to the annual expenditure limits set forth in the Special Terms and Conditions (STCs), will support participating Public Health Care systems providers that incur costs for uninsured care under the value-based global budget structure set forth in the STCs.
II. Designated State Health Care Programs (DSHP). Expenditures for costs of designated programs which are otherwise state-funded, are subject to the terms and limitations set forth in the STCs for the following programs.
- AIDS Drug Assistance Program (ADAP)
- Breast and Cervical Cancer Treatment Program (BCCTP)
- California Children’s Services (CCS)
- Department of Developmental Services (DDS)
- Genetically Handicapped Persons Program (GHPP)
- Medically Indigent Adult Long Term Care (MIA-LTC)
- Prostate Cancer Treatment Program (PCTP)
- Song Brown Health Care Workforce Training
- Mental Health Loan Assumption Program (MHLAP)
- Steven M. Thompson Physician Corps Loan Repayment Program (STLRP)
III. Uncompensated Care for Indian Health Service (IHS) and tribal facilities. Expenditures for supplemental payments to support participating IHS and tribal facilities that incur uncompensated care costs associated with services for which Medi-Cal coverage was eliminated by SPA 09-001 that are furnished by these providers to individuals enrolled in the Medi-Cal program.
IV. Delivery System Transformation and Alignment Payments. Expenditures for the following payments for Delivery System Transformation and Alignment.
- Public Hospital Redesign and Incentives in Medi-Cal. Expenditures for incentive payments for Public Hospital Redesign and Incentives in Medi-Cal (PRIME).
- Whole Person Care (WPC) Pilots. Expenditures for payments to entities operating an approved WPC pilot program. Such expenditures may include payments for services, supports, infrastructure and interventions, which may not be recognized as medical assistance under Section 1905(a) or may not otherwise be reimbursable under Section 1903, to the extent such services, supports, infrastructure and interventions are authorized as part of an approved WPC pilot program.
- Dental Transformation Incentive Program Expenditures for incentive payments to eligible dental providers that achieve dental transformation objectives set forth in the STCs.
V. Expenditures Related to Community-Based Adult Services (CBAS). Expenditures for CBAS services furnished to individuals who meet the level of care or other qualifying criteria.
VI. Expenditures Related to Low Income Pregnant Women. Expenditures to provide post-partum benefits for pregnant women with incomes between 109 percent up to and including 138 percent of the Federal Poverty Level (FPL), that includes all benefits that would otherwise be covered for women with incomes below 109 percent of the FPL.
VII. Expenditures Related to the Drug Medi-Cal Organized Delivery System (DMC-ODS). Expenditures for services not otherwise covered that are furnished to otherwise eligible individuals who are DMC-ODS beneficiaries, including services for individuals who are short-term residents in facilities that meet the definition of an Institution for Mental Disease. These facilities include, but are not limited to, Free-Standing Psychiatric treatment centers, Chemical Dependency Recovery Hospitals, and DHCS licensed residential facilities for residential treatment, and withdrawal management services.