The Medi-Cal Nursing Facility/Acute Hospital Waiver
(NF/AH Waiver) Renewal: Facts and Talking Points
1) What is the NF/AH Waiver and the Waiver renewal?
The Nursing Facility/Acute Hospital Waiver is a Medi-Cal program which pays for personal care services, home nursing care and many other services. It’s a home-based alternative for people who are on Medi-Cal and who qualify for “institutional” care, such as a nursing home. It is one way the state can comply with the Americans with Disabilities Act and the United States Supreme Court’s Olmstead decision, which say that people with disabilities, including seniors, must receive services in the most integrated setting.
The Waiver helps many people, but it could help many more people if changes were made. For many years, DRC has been fighting on behalf of individuals who have been forced to stay in institutions or have suffered at home without adequate services because of the rules the state has built into the Waiver.
2) What is a Waiver Renewal?
The Waiver is an agreement between the California Medi-Cal program and the federal government. The agreement lasts five years and then must be renewed. In the Waiver Renewal, the state makes important decisions about how many people will receive services, how much money will be available for services and what kind of services will be available. The current NF/AH Waiver was set to expire on December 31, 2016, but the State has asked for it to be extended until at least March 31, 2017. The State has submitted an application for a new Waiver. It is called the “HCB Alternatives Waiver.”
You can find it here: http://www.dhcs.ca.gov/services/ltc/Documents/HCB%20Alternatives%20Waiver_ADA_Compliant_Submitted%20122916.pdf. Last June, the state released a short summary of the proposed new Waiver. Here’s a link to the state website with the waiver proposal:
3) What are the important dates for the waiver renewal?
The proposed new Waiver makes three major changes which may improve the Waiver:
--An aggregate cost cap instead of an individual cost cap, which means that the money the state saves on lower-need and lower-cost Waiver participants can be used to cover the costs of higher-need and higher-need participants.
--Care management by local agencies rather than state nurses.
--An increase in slots so that up to 5,000 more people can get Waiver services.
4) Are these changes enough?
Talking points to improve the Waiver:
- Speed up the individual Waiver application process, which now takes six months or more
- Increase the number of people who can get waiver services. There are about 100,000 people in nursing homes at any one time, but the state is proposing to add only 5,000 slots over five years.
- Eliminate the waiting list. Now, people in the community, who are approved for the Waiver, wait two years to get services. The state’s proposal does not fix this problem.
- Base the overall (aggregate) cost cap on the full institutional costs. An aggregate cost cap is good, but only if there is enough money to meet all the medically necessary needs of the Waiver participants.
- Undertake an information campaign so that people know about the waivers, including consumers, IHSS social workers, hospital discharge planners and managed care plans.
- Raise the rates for Waiver providers, including the new care management agencies and direct service providers, to ensure that needed services are available.
- Streamline the enrollment and payment process for all Waiver providers so they will be willing to provide waiver services.
5) What happens next?
The State submitted the most recent application for the Waiver renewal on December 29, 2016. The federal government has 90 days to approve, or deny the application, or ask for more information. We will update this page as we learn more information.