Due Process in California’s Early Medicaid Expansion Program

I. Introduction: LIHP Due Process

 

Low Income Health Programs (LIHPs) were created in California in 2010 pursuant to a Medicaid Waiver, pursuant to Section 1115 of the Social Security Act. The waiver allowed California to begin expanding health care coverage to low-income individuals not otherwise eligible for Medi-Cal in 2011, as allowed under the Affordable Care Act, three years before the new Medi-Cal Expansion program was required, to be implemented. The LIHPs are governed by the Special Terms and Conditions (STCs) of the waiver, a contract between the state and federal government, which provides fifty- percent of the funding for the program. The STCs set out the notice and appeals process for the LIHPs.

This brief describes the notice and appeals rules in the LIHPs, and their implementation around the state. It also describes some lessons learned from the LIHPs? due process experience to prepare for California?s implementation of the Affordable Care Act in 2014.

 

II. Overview of LIHP due process requirements

 

The notice and appeals process for the LIHPs draw largely from federal Medicaid due process requirements, particularly those that apply to Medicaid managed care organizations. While there are some differences between the LIHPs and Medi-Cal, it is important to understand the basic framework of due process protections, as well as the specific federal and state laws that apply to Medicaid beneficiaries in health plans, in order to better understand due process protections for LIHP enrollees.