State releases draft 2015 Waiver (Medi-Cal 2020) application

Earlier this week, the Department of Health Care Services (DHCS) released a draft of the 2015 Section 1115 Waiver Renewal application, Medi-Cal 2020.  Of greatest interest to district/municipal hospitals, DHCS’s waiver renewal application includes the concept of shared savings with the federal government to be reinvested into the Medi-Cal program; and a set of delivery system transformation and alignment programs for all public hospital systems.  The application will be formally submitted to the Centers for Medicare and Medicaid Services (CMS) for consideration at the end of March. The document is available at:
We are pleased to note the draft (and ultimately the final application) includes district/municipal hospitals for participation in the DSRIP.  Inclusion in the Waiver has been an overarching goal of the Forum since its inception.  This is a direct result of DHLF advocacy at the state and federal levels (Administration, Legislature, Congress and U.S. Senate) and with our fellow hospital constituency groups.  A big thank you to all who have assisted via your grassroots advocacy including efforts at local levels.
The application includes key points made in DHLF advocacy, including a tiering approach for district/municipal hospitals participation in DSRIP (small hospitals would not be required to complete the same number/scope of projects as large district hospitals) and a 12-month funded planning period.  As the application states “the planning period will be critical to allow these facilities’ limited time and resources to be focused on the extensive work required to finalize plans, milestones, metrics, etc.  the NDPH systems likely will need to make investments beyond current staffing levels and a planning period would allow for both funding and time to ensure the appropriate innovative and non-traditional projects are thoughtfully considered before implementation has officially begun.”
We encourage member hospitals to continue the push at each facility for planning DSRIP projects, although the submission of the application will be the first official step in the communication (and back-and-forth) between DHCS and CMS (and ultimately the Forum on behalf of member hospitals). Some changes are anticipated, but the overall concepts (such as the domains for projects) should remain.
As you continue DSRIP planning, of interest are some DSRIP 1.0 examples included in the application.  These examples are an excerpt from an issue brief released by the California Association of Public Hospitals entitled “Leading the Way: The Delivery System Reform Incentive Payment Program (DSRIP).”  Available at: