MSSP provides both social and health care management services to assist frail individuals aged 65 or older to remain in their own homes and communities. To be eligible for MSSP, these individuals
must meet the criteria for skilled nursing facility care. The Program’s goal is to prevent or delay institutionalization through ongoing care management, using available community services and
resources, and purchasing needed services when they are not already available. The total annual combined cost of care management and other services must be lower than the cost of receiving
skilled nursing facility care.
MSSP operates under a Medicaid (Medi-Cal in California) 1915(c) Home and Community-Based Services (HCBS) waiver that has been approved by the federal Centers for Medicare & Medicaid Services.
The current waiver extends from July 1, 2019 through June 30, 2024. The California Department of Aging (CDA) administers MSSP under an interagency agreement with the Department of Health Care
Services. CDA’s MSSP Branch oversees the programmatic, fiscal, and service components of local MSSP site operations.
Under California’s Coordinated Care Initiative (CCI), most Medi-Cal beneficiaries in CCI counties must be enrolled in a participating Medi-Cal managed care health plan to receive their Medi-Cal
benefits, including MSSP. MSSP sites that provide waiver services in a CCI county have entered into agreements with participating managed care health plans to deliver MSSP waiver services to
eligible plan members. MSSP sites serving non-CCI counties deliver MSSP services as a Medi-Cal fee-for-service benefit. The CCI was previously scheduled to transition MSSP to a managed care
benefit effective January 1, 2023; however, effective January 1, 2021 MSSP will no longer be transitioned to managed care and will be carved out of CCI. MSSP will operate as a waiver benefit
in all CCI demonstration counties, as it did prior to the implementation of CCI in 2014.