Our case study sites illustrate how Medicaid waivers have helped strengthen the health safety net and provide a bridge to reform. California and Illinois have 1115 waivers for coverage expansion (LIHP/Healthy Way LA, and CountyCare); both states used their waivers to expand care to previously uninsured people and strengthen the capacity of the health care system in advance of full implementation of the Affordable Care Act.
Under California's 1115 waiver and with support from philanthropy, Los Angeles County pursued aggressive enrollment targets for Health Way LA while building connections that are benefitting people who are homeless or living in PSH. By providing coverage that offered a "bridge to reform" for people who became eligible for Medicaid in January 2014, California's waiver gave the Department of Health Services matching federal funding for costs of care provided in county hospitals and clinics, and an opportunity to make investments in improving the quality and efficiency of health care in the safety net delivery system. As described later in this report (Chapter 7), this allowed the department to make investments in strategies to target housing to people with long histories of homelessness and high levels of vulnerability, as well as to decrease avoidable hospitalizations and crisis care.
Cook County, Illinois, is addressing the needs of uninsured people with a broad package of benefits and improved connections among Health Centers and other providers serving low-income people, including people experiencing homelessness.
In both states, providers hoped the efforts they were undertaking to connect people to providers would build client loyalty so clients will stay with those providers later, even if they have other choices for obtaining care.