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California’s CalAIM (California Advancing and Innovating Medi-Cal) initiative was designed to transform care for people facing multiple health and social challenges, including homelessness and serious behavioral health conditions. Organizations implementing CalAIM programs have reported that these services are making a dif­ference for them and the Californians they serve. But what about the people themselves? In Their Own Words: What Californians with Multiple Health and Social Needs Say About Their Care focuses on their essential perspective. Participants’ direct quotes are included throughout the report.

In partnership with CHCF, EVITARUS interviewed 99 Californians across the state living with at least one of these four challenges: serious mental illness, homelessness, substance use disorders, or functional impairments like cognitive decline or vision loss. EVITARUS also conducted eight focus groups with caregivers. The goal was to understand what people with multiple health and social needs actually experience when they try to get care. The findings reveal both the promise of CalAIM’s vision and opportunities to improve implementation.

Key Findings

The research reveals six insights that can strengthen care delivery:

• Most participants (65%) experience four or more complex needs simultaneously, requiring coordination across multiple systems.
• Trust with providers is crucial — participants value empathy, fair treatment, and culturally resonant care.
• Basic needs like housing, food, and employment often take priority over health concerns.
• Participants face significant barriers to care, including long wait times and limited access, particularly for mental health and dental services.
• There is a strong desire for “one-stop shopping” models that integrate multiple services.
• Navigation support is essential, particularly for those with limited digital literacy or language barriers.

Care managers who coordinate appointments, arrange transportation, and help navigate complex systems were described by many participants as “lifesaving.”

Advisory Group Insights for Implementation

CHCF’s CalAIM Implementation Advisory Group provided specific reflections to translate these findings into practice. They highlighted the importance of patient autonomy — putting patients’ goals first and assisting them with what they say their primary need is. The group also highlighted the critical importance of hiring people with lived experience or a cultural connection to the community. They stressed that building trust takes time and consistent staffing. Working to reduce staff turnover is crucially important. Finally, care managers benefit from, and are more likely to stay, when they receive training in trauma-informed care.

The post In Their Own Words: What Californians with Multiple Health and Social Needs Say About Their Care appeared first on California Health Care Foundation.

About 1.6 million Californians face interconnected challenges that make it extraordinarily difficult to access health care and find the support they need within our complex web of health care and social services systems. They confront daunting hurdles whether they are experiencing homelessness or housing insecurity; struggling with serious mental illness; managing chronic conditions; or living with substance use disorder or cognitive decline.

To learn more about their perspectives, CHCF partnered with EVITARUS, a noted Los Angeles firm that conducts opinion research and public policy analysis. The firm’s extensive research included in-depth interviews with 99 individuals and eight focus groups of caregivers across California. The key takeaway? Trusted relationships improve care.

Recently, I interviewed Shakari Byerly, PhD, MPP, who led the research team and has a deep understanding of how social needs affect health outcomes. Her findings and observations reveal not only what assistance people need but the importance of delivering services with dignity, cultural understanding, and genuine care. Our conversation was edited for length and clarity.

Q: Your research uncovered several major themes about what Californians with multiple health and social needs value most when they receive care. The first one is trusted relationships with providers — a fundamental element that many people struggle to find.

A: We were really struck by how much the personal relationship matters, even when providers can’t meet every need. That relationship goes a long way toward making people feel listened to and treated with empathy. We thought of it as emphasizing the “care” in health care. In many situations, people said they didn’t feel that the caring nature of treatment was present. Some of this stems from system overload. Patients can see there isn’t enough housing or treatment program capacity available. The constant turnover in care managers was particularly frustrating. But when services were delivered with empathy, participants told us it made a tremendous difference by helping them feel seen and heard.

Q: Many participants talked about their goals and sense of agency during these discussions. How did that fit into the picture?

A: It starts with asking the person about what’s important to them. That can often get lost when we’re just trying to move people through services. People wanted to feel like they had some self-determination and to partner with their providers. Many said providers typically do not ask about the goals they might have for their own health or what being healthy and well would look like in their lives. Another common concern was that, given the complexity of the challenges they may be facing, providers often don’t recognize that they may not be able to follow through with aspects of the recommended treatment plan. Patients responded positively when they felt seen not as a case number but as a human being trying to be healthy and move toward stability.

Q: You mentioned cultural resonance as being particularly important. How does that differ from what we typically think of as cultural competency?

A: We’ve moved away from just checking boxes about cultural competency. Cultural resonance is about providers truly understanding nuances like language, family dynamics, or healing traditions. People need care that speaks to their lived experiences. Many participants talked about needing to experience fair treatment and the elimination of racism in care settings. That’s not only about individual provider behavior — it’s also about systemic change.

Q: You also found that people’s basic needs come before their health care. What surprised you most about how people with multiple health and social issues prioritize their needs?

A: Housing came up again and again — 61 out of 99 participants emphasized it as foundational. It has a direct impact on health. People without stable housing spend time every day meeting basic needs, such as keeping warm, obtaining food, taking a shower. That takes so much time that they neglect longer term concerns like health. But housing needs vary widely. People recovering from substance use disorder told us they’re often placed with others who are still using drugs or alcohol, and that jeopardizes their progress. Women with trauma histories sometimes find themselves in shelter situations that re-traumatize them.

Employment support came up too. Many people want to work and need that economic bridge before they can fully engage with health care.

Q:  How did health care services show up in these conversations?

A: People are frustrated that they often have to reach crisis levels before qualifying for help, particularly in the behavioral health system. That’s a system failure.

Participants want robust preventive services with flexible eligibility requirements. They may not be dealing with a serious mental illness but may need counseling and therapy. They want help maintaining their own stability, not just crisis intervention.

Dental needs connected to maintaining health were a recurring theme. Some participants, particularly seniors, talked about long wait times and how the default treatment under Medi-Cal was extracting teeth rather than repairing them. Living with missing teeth makes it harder for people to eat healthy food or to find a job.

What really came through was how interconnected everything is. Someone might have critical health care needs, but if they don’t have housing, healing becomes nearly impossible. They want to eat healthy foods, but they can’t do that until they can get their teeth fixed. The system often treats these as separate issues, but people experience them all at once.

Q: You identified integrated care and “one-stop shopping” as a key theme. What do you mean?

A: The people we interviewed were recruited by community-based organizations, which are trusted by their clients to provide an array of crucial social services. Participants told us if they could get a fuller range of services that include health care, counseling, and other supports at these familiar locations, it would transform their experience. The power of services coming to people rather than the other way around is especially crucial for seniors with mobility challenges and people in underserved rural areas. It also matters for people experiencing homelessness. Street medicine providers showed us the value of care navigators and street team members building relationships over time with people experiencing homelessness.  

Q: Navigating the system seems like it should be straightforward, but clearly it isn’t. What feedback did you get about the tremendous importance of care navigators?  

A: One quote really captures it: “If I don’t know what’s available, how do I know what to ask for?” People are told, “You just have to ask,” but they don’t even know what exists. Many people, especially seniors, struggle with resources that are only delivered online and want to walk into an office and talk to a person, even if there’s a wait. When you submit an online form, you don’t know where it goes or who sees it. There’s no way to follow up. And when information is translated into other languages, it can still be confusing or use terms people don’t understand.

Q: What do caregivers have to say about all this?

A: The emotional toll on caregivers — both family members and paid providers — is profound. Family caregivers need financial support because many are sacrificing their own income and health to provide care. They need training, mental health support, and respite care.

Q: What would meaningful change look like for the people you talked to?

A: It starts with hiring staff who have cultural and experiential backgrounds in common with the people they are helping. Those go a long way toward building trust and improving outcomes. We also need to address the high turnover rate in care management that forces people to start over with new providers by retelling their story and rebuilding trust.

We need trusted community organizations to provide more comprehensive services, either on their own, or by partnering with other organizations. More housing that is appropriate to people’s specific needs. And we need care managers who won’t assume people can figure it out themselves and will provide help navigating available services.

The system needs multiple entry points — not just digital platforms — with clear, accessible information about available services. And throughout all of this, we must center the human relationship. People want partners in their journey toward health, not just service providers checking tasks off a list.

Q: What does your research tell us about the future of health care in California?

A: These findings validate CalAIM’s efforts to achieve whole person care that recognizes how health, housing, and social needs interact. These new programs must honor what people told us they need: care delivered with empathy, cultural understanding, and respect for their agency. In addition to coordinated services, they need trusted relationships. Most importantly, we need to remember that behind every complex need is a human being trying their best to stay healthy and stable. If we can keep that humanity at the center of our reforms, we’ll build a system that truly serves all Californians.

Authors & Contributors

Melora Simon

Associate Director, People-Centered Care

Learn more about Melora Simon

Connect on LinkedIn

Harrison Hill

Photographer and Filmmaker

Harrison Hill is a documentary photographer and filmmaker based in Los Angeles, California. His work focuses on social justice issues centered around communities of color in the US.

Webpage

The post Trusted Relationships Are Essential for Californians with Multiple Health and Social Needs appeared first on California Health Care Foundation.

Across the country, states are recognizing that this growing subset of Medicaid members with complex health conditions who experience homelessness requires a different approach.

This issue brief, A Home and Healing: How Medicaid Improves Health and Lowers Costs Among Members Experiencing Homelessness, explores the reasons and methods behind multiple state Medicaid programs’ efforts to address the challenge of helping people move from the streets to permanent housing and health stability. The states cross the political spectrum and include Arizona, California, Louisiana, Maryland, Massachusetts, Montana, and North Carolina. The brief is available for download below.

A New Approach to Medicaid

States implementing these initiatives are discovering that addressing housing needs through Medicaid creates a pathway to better health outcomes while saving money. By covering services that help members secure and maintain housing, Medicaid programs can break the cycle that keeps people experiencing homelessness caught between the streets and emergency rooms.

The post A Home and Healing: How Medicaid Improves Health and Lowers Costs Among Members Experiencing Homelessness appeared first on California Health Care Foundation.

For older adults and people with disabilities, long-term services and supports (LTSS) provide crucial assistance with daily activities like eating, bathing, and medication management. Although some receive care in nursing facilities, many prefer staying in their homes with support from home and community-based services (HCBS).

California is joining other states in shifting Medicaid LTSS from fee-for-service to managed care. This transition offers promising opportunities to:

• Enhance coordination for HCBS users
• Improve state cost predictability
• Strengthen service delivery systems

However, without careful planning, these changes could disrupt vital care for vulnerable Californians.

Learning from Experience

California can benefit from the experiences of 24 states that have implemented Medicaid managed LTSS (MLTSS) over three decades. Their journeys reveal key strategies for success:

• Implementing robust continuity-of-care protections
• Building and maintaining strong provider networks
• Establishing proactive oversight mechanisms

This explainer, Moving HCBS to Medicaid Managed Long-Term Services and Supports: Considerations  for California and Other States, highlights practical approaches to guide California’s transition to MLTSS. By applying these lessons, California can create a system that honors individual preferences, supports community living, and ensures high-quality care for those who depend on these essential services. CHCF is proud to support the production of this paper.

The post Moving HCBS to Medicaid Managed Long-term Services and Supports appeared first on California Health Care Foundation.

As a physician, I have witnessed patients struggle with health issues caused or complicated by housing instability. It is terribly distressing to see a patient who could potentially live a healthy life encounter persistent structural obstacles to regaining a safe and reliable place to live.  

On March 12, I had the privilege of moderating a CHCF briefing that brought together leaders from California state government and providers of health care and social services to discuss how Medi-Cal’s three housing Community Supports are addressing homelessness. The “housing trio” — housing transition navigation services, housing deposits, and housing tenancy and sustaining services — were developed through Medi-Cal’s CalAIM initiative; they are designed to bring a more integrated and people-centered approach to caring for people with the most complex health and social needs, including those experiencing homelessness.  

More than 100 people attended in person at the Department of Health Care Services (DHCS) auditorium in Sacramento, and 650 more watched the live webcast. This strong attendance underscored the urgency and importance of the homelessness problem to our state. You can watch the complete video replay on our website.  

The Intersection of Health and Housing

Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative at UCSF, opened the briefing with insights from the California Statewide Study of People Experiencing Homelessness. She highlighted the ways that homelessness combines with physical and behavioral health problems to create a vicious cycle: Health issues increase the risk of homelessness, and living unhoused worsens health through exposure to trauma, sleep deprivation, environmental hazards, and impeded access to care. 

Kushel emphasized that the right interventions at the right time can prevent, mitigate, or end homelessness. While many will eventually resolve their housing situation independently, strategic support can dramatically reduce the duration of homelessness from years to months or even weeks. 

Cross-Sector Collaboration Breaks Down Barriers

The heart of the briefing was a panel discussion that started with the elephant in the room: how DHCS is thinking about the future of CalAIM in the face of federal uncertainties. 

Susan Philip, MPP, the DHCS deputy director of health care delivery systems, was crystal clear in her response. “As a state, as a department, we are fully committed to Community Supports and the scaling of them. We’re not going to speculate what the federal government might do, but … just to reiterate … we are fully committed. As [DHCS] Director Michelle Baass likes to say, ‘We are pedal to the metal on this.’”  

The panel discussion revealed both the challenges and the promising solutions that have emerged through the CalAIM initiative and the housing Community Supports. 

Cheryl Winter, MPH, associate director of California state policy at the Corporation for Supportive Housing, highlighted a fundamental challenge: Housing and health care organizations operate in different worlds with different languages, systems, and, crucially, funding mechanisms.  

“Homeless and housing service providers are having to enter into a new and very complex system of care, moving from a grant-funded system where you’re receiving funding up front, and you serve as many people as you possibly can, to one where you submit the data and reports and receive payment 30 to 90 days after services are provided,” Winter said. This misalignment creates significant cash flow challenges for community-based organizations (CBOs) trying to provide housing supports. 

Philip pointed to the emergence of “flex pools” as a promising strategy.  

“These local administrative entities braid together different funding streams to address cash flow problems,” Philip said. “They’re helping housing providers cover immediate costs like deposits and transitional rent that would otherwise be impossible under traditional Medi-Cal reimbursement timelines.” 

She added that administrative “hubs” are becoming critical intermediaries between CBOs and Medi-Cal managed care plans. These hubs handle the complex claims and invoicing processes so that each community-based organization doesn’t have to become a Medi-Cal billing expert overnight, she said. “That way, the CBO can focus on the bread and butter of actually serving the Medi-Cal members, and the administrative hub can work with the managed care plans on billing,” Philip said. 

The Housing Supply Challenge

Even with these innovations, there simply aren’t enough affordable units available for people with low incomes. 

“There are tens of thousands of people now receiving housing transition navigation services through Medi-Cal, which is incredible,” Winter said. “But providers have nowhere to navigate them to. This impacts everyone — the member, the providers, and the plans.” 

This reality resonated deeply with me. During my years practicing alongside Kushel at San Francisco General Hospital, we often wished we could write a “prescription for housing.” Today, through CalAIM, we’re closer to that reality. But unless the underlying housing shortage is addressed, our efforts will fall short. 

Expanding the Housing Support Toolkit

Philip detailed how DHCS has strengthened its commitment to whole-person care through CalAIM. “We know that housing stability is crucial for health and well-being, directly impacting physical, mental, and behavioral health,” she said. 

Beyond the initial trio of housing Community Supports, DHCS now offers these housing supports: recuperative care and short-term post-hospitalization housing. In December, the department began covering six months’ rent for unhoused people with complex health needs or transitioning out of a treatment, detention, or shelter facility. 

Setting Ambitious Goals Through Interagency Collaboration

Dhakshike Wickrema, MCP, the deputy secretary of homelessness at the California Business, Consumer Services and Housing Agency (BCSH), shared how the California Interagency Council on Homelessness is coordinating efforts across state departments and agencies. 

Its Action Plan for Preventing and Ending Homelessness in California has a goal of increasing the percentage of people experiencing homelessness who move into permanent housing from 18% a year to at least 60% annually over three years. 

“That’s an ambitious goal, but it’s the way we want to make sure every state agency and every state department is thinking about how to help people exit unhoused situations to permanent housing situations,” said Wickrema. “Those are places where there’s a sense of stability, a sense of dignity, where people can really take care of their health and be reunited with family and friends if that’s something they want to do, but really use CalAIM and other resources to turn that chapter in their lives.” 

This cross-sector approach is showing promising results. According to the statewide Homeless Data Integration System, about 63,000 people moved from homelessness into permanent housing in 2024. Philip noted that a forthcoming RAND/UCLA study will provide more comprehensive data on outcomes for individuals receiving housing Community Supports, including emergency department use and total cost of care. 

Audience Questions

From there, we invited audience questions, but unsurprisingly we could not get to all of them in the time remaining. Here are my responses to some additional questions from the Zoom audience that weren’t addressed at the briefing.  

Q: In Santa Barbara County, we have many providers of services. What is challenging is that to coordinate care holistically, it’s hard to link efforts. Any suggestions about how to make this work more seamlessly? 

A: This is a great question. Effective cross-sector partnerships are the cornerstone of work to improve outcomes for people experiencing homelessness. Coordination and collaboration take planning and care. A two-year, CHCF-funded project focused explicitly on bringing together partners from the health care and homelessness sectors, and it recently concluded. This brief captures lessons from that initiative. Here are a few takeaways:  

• Don’t just talk, do something! Come up with a project that would benefit from cross-sector engagement, and don’t let development of a perfect plan keep you from getting started. Our teams found that it’s better to get going, learn from doing, and adapt as needed rather than risk “analysis paralysis.” 
• “Boundary crossers,” the people who work in one sector and then move to work in another, play a crucial role in facilitating relationship development and progress between collaborating sectors.  
• Engaging people experiencing homelessness and/or those with lived experience of homelessness offers valuable insights that can inform the development of programs that will impact them and their community. 

Beyond these insights, communities in California can use resources that are available to support cross-sector collaboration. For example, the Providing Access and Transforming Health (PATH) Technical Assistance Marketplace offers free resources and technical support to help organizations implement Enhanced Care Management and Community Supports.  

Q: Each county in California has a different managed care plan assigned, and the individual counties often manage their own version of Medi-Cal. There is no data sharing within the county and plans. Often unhoused folks move from county to county, which poses a problem. How would you advise the plans to support these efforts? 

A: Although Medi-Cal is a statewide program, each of California’s 58 counties separately administers the program for most residents who live within that county. When someone moves to a new county and wants their Medi-Cal to continue, they need to ask for an “inter-county transfer.” The transfer process can be especially complicated for people experiencing homelessness. 

In that vein, we supported Homebase and the Western Center on Law and Poverty to create a practical guide, Moving with Medi-Cal: Inter-County Transfers.  

The Pathway Forward: Integration and Collaboration

A clear consensus emerged from our discussion at this briefing: No single sector can solve homelessness. The health care system brings valuable skills in assessment and individualized care planning. Housing experts understand the complex landscape of affordable housing resources. Government agencies provide crucial funding and policy frameworks.  

Only by working together can we create lasting solutions. 

The integration of Medi-Cal housing supports was a significant step forward in California’s approach to homelessness, which recognizes that health and housing are inextricably linked. While challenges remain, particularly around housing supply and cross-sector coordination, the innovations give us reason to be hopeful. 

As I reflect on the rich discussion at our briefing, I’m reminded that behind every statistic is a person deserving of dignity, health, and a place to call home. By breaking down walls between health care, housing, and social services, we’re building a more compassionate and effective system for Californians experiencing homelessness. The journey ahead is long, but partnerships forming today are laying the groundwork for effective and meaningful change. 

Authors & Contributors

Michelle Schneidermann

Director, People-Centered Care

Learn more about Michelle Schneidermann

José Luis Villegas

Independent photojournalist

José Luis Villegas is a freelance photojournalist based in Sacramento, California, where he does editorial and commercial work. He has coauthored three books on Latino/x baseball. His work appears in the Ken Burns documentary The 10th Inning and in the ¡Pleibol! exhibition that debuted at the Smithsonian Institution’s National Museum of American History and has been appearing at museums around the country.

Villegas’s work has been exhibited at the Museum of Fine Arts-Houston; the Baseball Hall of Fame in Cooperstown, New York; and at the Oakland Museum of California. Villegas also works as a medical photographer at Shriners Hospital in Sacramento.

The post How Medi-Cal Is Tackling Homelessness Through Innovative Housing Solutions appeared first on California Health Care Foundation.

When most people think of Medicaid, they think of health insurance — a public program for low-income families, older adults, children, and people with disabilities. But that’s only part of the story. Medicaid isn’t just about health coverage. Medicaid is one of the largest and most effective economic engines in the United States.

Each year, the federal government alongside states invest billions of dollars into Medicaid. That money doesn’t sit in government accounts — it moves through communities. It keeps hospitals open, supports hundreds of thousands of jobs, sustains rural health systems, and fuels a growing workforce of home care aides, behavioral health providers, and community-based service workers. For every dollar spent, Medicaid generates ripple effects far beyond health care. It helps the restaurant worker stay employed, enables older adults to remain in their communities, and gives entrepreneurs the security to open their small businesses.

Medicaid, the Economic Driver

Yet despite this, Medicaid is rarely discussed as an economic driver.

Too often, it’s treated as little more than a budget line — a cost to be managed or trimmed. But this view is dangerously short-sighted, especially now.

The country is at a crossroads. Pandemic-era coverage protections have ended, and more than 10 million people have already lost Medicaid as part of the so-called “unwinding” process. Meanwhile, states are grappling with strained safety-net systems, workforce shortages, and budget uncertainty. These challenges are real — but so are the opportunities.

Because Medicaid is about more than health insurance. It’s about jobs, stability, and economic growth.

Every time Medicaid pays for a doctor’s visit or funds a home health aide, that payment supports a job. That job supports a family. That family strengthens a local economy. And as Medicaid evolves — covering services like housing supports, nutrition, behavioral health, and social services — its economic impact only grows.

It also boosts workforce participation. When people have health coverage, they stay healthier, miss fewer days of work, and avoid financial ruin from medical bills. Medicaid gives working parents, caregivers, and people managing chronic conditions the stability they need to stay employed and contribute fully to their communities.

Reframing Our Understanding of Medicaid

The evidence is clear, especially in states that expanded Medicaid under the Affordable Care Act. Expansion has fueled job growth, strengthened hospitals, improved family financial stability, and helped prevent rural health systems from closing their doors.

I saw this firsthand in California, where I served as Undersecretary of the state Health and Human Services Agency. Medi-Cal, the state’s Medicaid program, covers more than 15 million people — roughly one in three Californians. Through initiatives like CalAIM, California has used Medicaid funding not just to treat illness but to tackle the root causes of poor health: housing instability, food insecurity, mental illness, and more. Along the way, the state has created new opportunities for employment and forged cross-sector partnerships that strengthen both community health and local economies.

This kind of innovation should be the norm — not the exception. But it requires reframing how we see Medicaid.

Proposed federal Medicaid cuts could lead to 217,000 lost jobs in California, $37 billion in reduced economic output in the state, and $1.7 billion in lost state and local tax revenue, according to the UC Berkeley Labor Center.

At the same time, two recent polls — one national by the Kaiser Family Foundation (KFF) and another focused on California by the California Health Care Foundation (CHCF) — show overwhelming bipartisan support for Medicaid. The KFF poll found that 82% of Americans want Medicaid funding to be either maintained or increased, while only 17% support cuts. In California, the numbers are even more striking: the CHCF poll found that 87% of Californians want Medi-Cal funding preserved or expanded, with just 13% favoring cuts. And for many, Medicaid is personal — more than half of Americans say they or a family member have benefited directly from the program. These numbers cut across political, geographic, and demographic lines, underscoring that Medicaid isn’t just popular — it’s essential.

Medicaid, the Strategic Asset

Policymakers in Washington, D.C., face hard fiscal choices. But weakening Medicaid would be counterproductive. It would hurt families, destabilize local economies, and undercut workforce participation at a time when employers are already struggling to hire and retain talent.

The question we should be asking isn’t whether we can afford Medicaid — it’s how we can make Medicaid work harder for our communities. How can we align it with other public and private investments to drive better health outcomes and greater economic resilience?

The answer starts by seeing Medicaid not as a budget burden, but as a strategic asset — a catalyst for growth, stability, and economic prosperity.

In a time of economic and social uncertainty, we have a choice: pull back or invest in smarter systems that deliver for people and strengthen the economy. Medicaid should be at the center of that strategy.

It’s time we start treating it that way.

This article first appeared in LinkedIn on April 13, 2025 and is reprinted here with permission. The author updated it with additional data before publication here.

Authors & Contributors

Marko Mijic

Former undersecretary, California Health & Human Services Agency

Marko Mijic is the former undersecretary of the California Health and Human Services Agency (CalHHS). He is currently a managing director at Sellers Dorsey and an Impact Fellow at the UC Berkeley School of Public Health.

At CalHHS, he managed 12 departments and five offices, overseeing more than 34,000 employees and an annual budget exceeding $260 billion. In this role, he focused on refining government operations, enhancing access to health and human services, and advancing an equitable recovery from the pandemic. He served under two governors and three CalHHS secretaries during his tenure.

Mijic’s leadership emphasized improved services for marginalized communities, including older adults and individuals with disabilities, grounded in a commitment to justice, equity, diversity, and inclusion. 

The post Medicaid Is One of America’s Strongest Economic Engines. Why Don’t We Treat It That Way? appeared first on California Health Care Foundation.

Community-connected workers — including community health workers, promotores, and peer support specialists — play a crucial role in CalAIM implementation. In summer 2024, CHCF surveyed 948 people working on the ground to implement CalAIM programs. This fact sheet compares findings from the survey of 302 leaders from organizations who employ community-connected workers to 117 leaders whose organizations do not.

Organizations with community-connected workers report greater improvements for specific populations compared to those without:

• Better care for Latino/x populations (49% vs. 38%)
• Better care for people experiencing homelessness (59% vs. 41%)
• Better care for people with serious mental health or substance use disorder needs (49% vs. 37%)

Overall, 62% of leaders at organizations employing these workers report improved client care experience due to CalAIM, compared to 46% at organizations without them.

Why Organizations Value Community-Connected Workers

Community-connected workers are valued for their ability to:

• Create connections with clients through shared experiences
• Reach diverse communities
• Serve those with limited English proficiency

Organizational Characteristics

Organizations employing community-connected workers tend to be larger, have prior experience with whole-person care initiatives, and serve a wider range of populations with complex needs.

The fact sheet is available for download below.

The post CalAIM Experiences: The Community-Connected Workforce appeared first on California Health Care Foundation.

View the Report

The Enhanced Care Management (ECM) program, launched in January 2022 as part of California’s CalAIM (California Advancing and Innovating Medi-Cal) initiative, represents a significant transformation in how Medi-Cal serves members with complex needs. This report, Perspectives from the Field: Up Close with ECM Providers, examines the early implementation experiences of ECM across different populations of focus (PDF).

During summer 2023, a UCSF Health Systems Leadership Pathway team interviewed 18 organizations providing ECM services across California. Their investigation revealed four critical insights:

• ECM Implementation Is Complex
  • Organizations face challenges including variable provider capacity, inconsistent data quality from health plans, diverse needs across different populations, varying requirements between managed care plans, and limited established protocols in this new program.
• Variation Is the Norm
  • The absence of standardized approaches to ECM delivery across California has created significant administrative burdens for providers, who must adapt to different systems and requirements.
• Success Is Being Achieved
  • Despite obstacles, ECM providers are effectively helping patients navigate fragmented systems and access needed services, demonstrating the program’s potential value.
• Better Measurement Standards Are Needed
  • Beyond enrollment and engagement metrics, ECM providers lack key performance indicators to target and measure program impact, making it difficult to demonstrate outcomes.

Program Evolution

ECM implementation has been phased, beginning in 2022 with three populations in 25 counties and expanding statewide six months later. Additional populations were added throughout 2023, with the final two — birth equity and people transitioning from incarceration — launching in January 2024.

This report offers valuable guidance for providers, Medi-Cal managed care plans, and California Department of Health Care Management administrators as they continue to develop ECM as a critical benefit for Californians with complex medical, behavioral, and social needs. The findings highlight both challenges and opportunities in this ambitious effort to transform care delivery for vulnerable populations.

About the Authors

A research team of UCSF medical residents and fellows worked with a team from California’s Department of Health Care Services to interview 18 ECM organizations. Providers describe their implementation efforts, impact of the program so far, and rollout challenges.

Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities.

From UCSF Health Services Leadership Pathway:

• Justin Zhang, MD, a third-year internal medicine resident
• Helen Pu, MD, a pediatric hospital medicine fellow
• Diana Funk, MD, a chief resident in internal medicine
• Reem Al-Atassi, MD, now completing a fellowship at the University of Pittsburgh Medical Center
• Edgar Pierluissi, MD, professor of clinical medicine at UCSF, and faculty adviser for the Health Systems Leadership group

Authors & Contributors

Claudia Boyd-Barrett

External Author

Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities. Her stories have appeared in the Los Angeles Times, San Francisco Chronicle, San Diego Union-Tribune, and California Health Report, among others.

Boyd-Barrett is a two-time USC Annenberg Center for Health Journalism fellow and a former Inter American Press Association fellow.

UCSF Health Systems Leadership Pathway

The post Perspectives from the Field: Up Close with ECM Providers appeared first on California Health Care Foundation.

Life slowed down for truck driver James Bryant, 76, after he retired in 2011. He found himself stuck at his Los Angeles home a lot more. His social circle was narrowing, and chronic arthritis and a bad back made it even harder to get out. 

Three years ago, Bryant got a phone call from Claudia Mata, a community engagement liaison for a program called Wider Circle. Her organization had contracted with his Medicare plan to organize social get-togethers for older members in his area. Would Bryant and his wife, Mary, like to come to a free breakfast at IHOP?  

“I said, sure, why not?” he recalled. It seemed to him to be an opportunity to get out of the house. “We’ve been coming to meetings ever since,” Bryant said. “We enjoy ourselves. It’s our outing.” 

Bryant was one of about 40 people playing bingo, chatting, laughing, and sharing in a potluck at a recent Wider Circle celebration of Black History Month at a community center in Inglewood. It’s one of hundreds of gatherings in neighborhoods across California each month that are organized by the company. The events encompass a range of activities, including community potlucks, board games, group walks, health workshops, coffee shop meetups, movie outings, dance parties, and museum visits. Facilitators also host virtual get-togethers for members who can’t get to or prefer not to attend in-person events.  

Between the community events, Wider Circle regularly checks in with members by phone or in person to see how they’re doing. Participants are invited to attend events based on where they live and other shared characteristics, such as language. The meetings are designed to help members connect with people from similar backgrounds so they can form friendships and interact socially. 

While it may seem like a kind of social club, Wider Circle is actually a health intervention. Studies show that bringing people together this way decreases loneliness and isolation and can lead to significant improvements in physical and mental health. 

Tackling Loneliness to Improve Health

Participants enroll in Wider Circle through their health insurance plans. About two-thirds of Californians served by the program are eligible for both Medicare and Medi-Cal (California’s Medicaid program), and many are enrolled in Dual Special Needs Plans (D-SNPs). Americans eligible for and enrolled in both Medicaid and Medicare, or dually eligible enrollees, are more likely than Medicare-only beneficiaries to live with limited financial means and complex health challenges.  

“Loneliness has been shown to worsen cardiovascular disease, mental health, Alzheimer’s progression, inflammatory diseases,” said Claude Pinnock, MD MPH, Wider Circle’s chief medical officer.  “Tackling loneliness will improve outcomes and improve comorbidities, which will lower the cost of care as well and drive higher value to our members.” 

Wider Circle launched a decade ago in the San Francisco Peninsula community of Redwood City. Founders Darin Buxbaum and Moshe Pinto, medical device entrepreneurs who met at Stanford University, were inspired to tackle the crushing effects of loneliness that they had seen disrupt the lives of their own family members. Buxbaum had watched his grandmother’s physical health decline rapidly after his grandfather died and she began spending more time alone. Pinto saw his mother lose her zest for life as she became less sociable with age. In the last several years, the issue of chronic loneliness was highlighted by former US Surgeon General Vivek Murthy amid growing scientific and cultural interest in the problem. 

Buxbaum and Pinto delved into research on loneliness, sifting through around 600 studies that included landmark studies from the 1970s that correlated mortality risk with social isolation. Research from the United Kingdom showed that bringing people together in groups improves their health.  

“The more we looked at the research, the more it became clear that people need other people, and people need purpose. It’s not that complicated,” Buxbaum said. “We saw these seminal papers and asked, ‘how are people not doing something about this?’” 

Wider Circle held its first community gatherings at a senior center in Redwood City that catered to participants from a range of socioeconomic backgrounds. After those events received good feedback, the city asked Buxbaum and Pinto to bring the program to older adults living in publicly subsidized private rental housing and struggling with economic hardship and extreme isolation. As these adults met and socialized week after week, Buxbaum saw their outlooks change dramatically for the better.  

‘Groups Become Their Family’

“One person said life was a very, very dark tunnel, and the program became this light that helped guide her out of that tunnel,” Buxbaum said. “I’ve had members literally come up and hug me and say the program saved their life. That they used to think about throwing themselves in front of a car and now they have something to look forward to. The groups become their family.” 

Convincing investors to take a chance on the fledgling company proved challenging, however.  At the time, venture capital firms preferred to invest in machine learning, a type of artificial intelligence, Buxbaum said. Many investors scoffed at the proposal of bringing humans together to solve loneliness. They suggested Buxbaum and Pinto start a nonprofit and apply for grants. 

Eventually, Wider Circle secured significant funding to expand the program nationally. Backers include AmeriHealth Caritas, Blue Venture Fund, Kaiser Permanente Ventures, and Chicago Ventures.

Last year, the California Health Care Foundation’s Innovation Fund invested $1 million in Wider Circle and has committed to provide an additional grant worth $250,000. CHCF invests in companies using innovation and technology to improve the health of Medi-Cal enrollees.  

Stella Tran, senior program investment officer for the Innovation Fund, said she was impressed by the company’s ability to serve older members and facilitate engagement on a large scale.  

“It can be challenging for anyone to reach out for social connection and support — it isn’t only older adults who have become increasingly isolated,” Tran said. “Wider Circle has a simple, elegant model that removes all the barriers to social connection, enabling the company to deliver programs and activities that address health outcomes and encourage engagement in health.” 

The California Department of Health Care Services (DHCS) under CalAIM has mandated that all local Medi-Cal managed care plans establish D-SNP programs. Many plans lack the capabilities to operate a D-SNP program. Wider Circle helps plans comply with the mandate by enhancing care coordination for enrollees with dual eligibility. In the process, Wider Circle gathers valuable data on the health needs of a patient population that can be hard to reach and resistant to engagement.  

The model makes it easier for health plans to connect with hard-to-reach members, particularly D-SNP enrollees, and encourages them to take actions that support their health, Tran said. In addition to social activities, Wider Circle events often include talks or workshops on topics such as diabetes care or preventive screenings. As they build relationships, members end up supporting each other in making healthy decisions, such as taking time to exercise and get medical checkups, organizers said.  

Wider Circle works with health plans and provider groups that serve Medicare and Medicaid beneficiaries in 14 states. In California, the company contracts directly with Health Plan of San Mateo, Health Plan of San Joaquin, Optum, and Champion Health Plans, as well as Molina Healthcare, Anthem Blue Cross, Inland Empire Health Plan, and Central California Alliance for Health through a joint venture with Astrana Health.

Health Plan of San Mateo has contracted with Wider Circle since 2014. The plan initially offered the program to a subset of its older population, and opened it to all dual-eligible plan members when it became clear that it boosted participants’ quality of life, said Chief Medical Officer Chris Esguerra. Wider Circle groups help the plan communicate health information to members. Because the information is shared by facilitators and other participants whom they trust, members are more likely to listen than if they only receive a flyer at the doctor’s office, he said.

Peer-reviewed research involving Wider Circle associates the company’s interventions with reducing health care costs, increasing member retention in health plans, improving access to preventive and primary care, and decreasing hospital visits.  

Matching Participants with Common Interests, Backgrounds

Wider Circle brings most members into the program in groups of 12 to 15 people. Participants are matched based on details from claims data that show common interests or backgrounds, such as neighborhood, ethnic or linguistic similarities, or comparable health challenges. These mini groups meet regularly for 4 to 6 weeks and are coordinated by a trained facilitator — typically someone who is also from that community. Once the introductory sessions finish, they’re invited to join their local Wider Circle chapter and participate in larger events throughout the month.  

Starting with a small group helps participants begin to build strong relationships with like-minded peers and creates a little community that persists even after they join the larger chapter. Groups elect a volunteer peer ambassador to continue to facilitate relationships among members of the small cohort after graduation, such as by organizing meetups or giving each other rides to and from Wider Circle events. Some small groups have continued to meet for years and developed deep friendships. Peer ambassadors also help Wider Circle facilitators set up and run gatherings.  

Delfina and Ricardo Recinos, of Inglewood, both 67, joined Wider Circle a year ago and still meet with the people from their introductory group of 12 to celebrate birthdays. The couple also attends as many Wider Circle chapter gatherings as they can. The Recinos, whose primary language is Spanish, said Wider Circle has been good for their mental health. 

“After retiring, you have to look for activities, and this is a way to be able to have those experiences, that contact with other people, to get to know people, support each other,” said Ricardo Recinos, who used to work as an airport cargo handler. 

Joscelyn Jenkins , 71, of Arlington Heights, joined Wider Circle in 2022 and is now a peer ambassador. She frequently gives rides to peer group members so they can attend events like visiting the California Science Center, taking walks, and performing Karaoke. The role has given her purpose, she said. 

“It gives me a sense of community, a sense of making a difference in someone else’s life, to know they have someone that’s on their side who will be there for them,” she said. “This is a way for me to meet others and share my gifts and my talents.”    

For James Bryant, the retired truck driver, and his wife, Mary Bryant, Wider Circle gatherings have become a regular fixture on their calendar. Meeting new people and doing different activities — whether that’s playing bingo or doing stretches with a group — gives them a needed mental boost, they said.  

“You’re not at home watching TV,” James Bryant said. “It keeps your mind going.”  

Authors & Contributors

Claudia Boyd-Barrett

Independent journalist

Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities. Her stories have appeared in the Los Angeles Times, San Francisco Chronicle, San Diego Union-Tribune, and California Health Report, among others.

Boyd-Barrett is a two-time USC Annenberg Center for Health Journalism fellow and a former Inter American Press Association fellow.

See More

Harrison Hill

Photographer and filmmaker

Harrison Hill is a documentary photographer and filmmaker based in Los Angeles, California. His work focuses on social justice issues centered around communities of color in the US.

See More

The post Wider Circle Getting Big Results from Its Strategy to Ease Loneliness appeared first on California Health Care Foundation.

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Medi-Cal managed care plans can now provide services to help unhoused members apply for, secure, and sustain housing. This “housing trio” is part of the 14 Community Supports added as part of the state’s CalAIM initiative, a multi-year effort to reform the way Medi-Cal services are delivered. These 14 services, which range from providing medically tailored meals to assisting with nursing facility transitions, are aimed at addressing members’ unmet social needs and helping people avoid costlier levels of care.

The three services are:

• Housing Transition Navigation Services: assistance with finding and securing housing
• Housing Deposits: assistance with first and last months’ rent payments and items to set up a basic household
• Housing Tenancy and Sustaining Services: support in maintaining stable tenancy after moving in

The housing trio is an evidence-based bundle proven to help people experiencing homelessness get and keep housing. All three of the services are now offered in every county across the state, making them among the most widely adopted Community Supports. More than 75,000 people used a housing support between July 2023 and June 2024. The housing trio services are also effective in helping providers offer more comprehensive care to more people. In a 2024 survey of CalAIM implementers, 84% of specialist homeless services providers contracted with managed care plans report that they are more able to manage the comprehensive needs of the people they serve under CalAIM. In addition, 78% report that they have been able to grow the number of people they serve.

Housing Trio in Action. Josh is a 55-year-old Medi-Cal enrollee who lived in an encampment visited regularly by a street medicine team. Josh was seen for diabetes management, and during one visit, the street medicine provider found that Josh had a high fever and a severe infection in his foot. He was brought to the hospital and unfortunately required amputation. Josh was discharged to a skilled nursing facility for physical therapy and wound care. While there, his enhanced care manager from the street medicine team connected him to a homeless services provider, and his managed care plan approved him for housing transition navigation services. His care manager helped get him “document ready,” tracking down the identification Josh needed to apply for affordable housing.

It took several months to get Josh’s paperwork together, including getting him enrolled in Supplemental Security Income (SSI) benefits, and an additional eight months for a housing placement to become available. At that point, the homeless services provider secured authorization from his managed care plan for housing deposits, which helped Josh pay the deposit for his apartment and modify the apartment to include grab bars. Once housed, Josh also received tenancy and sustaining services from the same provider to help him maintain his housing. Since Josh had lived outdoors for many years and wasn’t accustomed to paying rent, he initially fell behind on payments, but his tenancy and sustaining services case manager helped advocate to the landlord to prevent Josh’s eviction and arranged for Josh’s rent to be deducted from his SSI check automatically. The case manager also worked with Josh when it came time to recertify for his financial benefits.

The post CalAIM’s Trio of Housing Community Supports – Policy at a Glance appeared first on California Health Care Foundation.

Fueled by billions of dollars of investments, California’s public behavioral health system is on a transformative journey toward new and innovative models of care. Yet, despite these exciting changes, many Californians with mental illness or substance use disorder continue to face big problems accessing the support they need. The key to getting this population better access to care and improved health outcomes lies in unlocking the data that reveal who is being served and what interventions work. As state leaders rethink behavioral health data systems, it is crucial that they listen to the voices of providers and administrators on the front lines.  

Understanding health care data is a valuable and powerful tool. Talking about managing data may be less exciting than discussing innovative treatments or seeing a person get care they need, but like a Rosetta Stone, data reveal who is and isn’t being served, highlight what is working, and determine where dollars go. This in turn affects access, quality, and outcomes. 

While California’s public behavioral health system has always amassed lots of data, that information has been burdensome to collect and too inconsistent to tell a clear story. Now, the state has embarked on ambitious efforts to improve integration of behavioral health data across systems and programs. This effort is organized under the Behavioral Health Transformation umbrella, which includes the Medi-Cal CalAIM initiative and the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) initiative, as well as the Behavioral Health Services Act (Proposition 1) passed by voters last year.  

CHCF and the Behavioral Health Data Project recently published a report that analyzes public behavioral health services’ data collection, measurement, and reporting practices. The  authors interviewed state and county administrators and behavioral health providers. Here are their pain points and priorities for state and local action as California endeavors to align and modernize behavioral health measurements.   

Understanding Health Care Data

Administrators and providers were concerned that behavioral health data they collect may not be very helpful, can be voluminous, and often is gathered via burdensome processes. For instance, some processes still require extensive manual data entry, resulting in high costs for staffing and software resources as well as decreased data quality and timeliness. 

As well, California’s 58 counties lack uniform data requirements, and those disparate requirements are not consistently reflected or updated in providers’ contracts. Counties are sometimes required to send the same data to multiple state agencies — or even to multiple departments within the same agency.  

When it comes to data collection, counties, public and private managed care plans, hospitals, schools, and jails all play different roles. Sharing data across a siloed system is challenging. Yet, many exciting new initiatives in the public behavioral health system depend on better data linkages between Medi-Cal managed care plans and county behavioral health plans, or between health care and housing systems.  

Finally, challenging processes and poor quality limit the utility of some data just. For example, Full Service Partnership programs collect a wide array of data using three distinct collection forms. However, outdated technology at the state level and inconsistent protocols at the local level mean that these data can’t reliably demonstrate the value of those programs across California.  

Focus on Measuring Quality and Outcomes

Behavioral health measures fall into broad categories: service use, service cost, quality of care, outcomes, and demographics and equity. Because funding and payment have traditionally driven reporting, the system is more practiced at measuring service use and cost than the other categories.  

Interviewees agreed that California needs to go beyond tracking provided services and begin identifying and reporting on the quality of services by:   

• Using process-oriented quality measures, such as Healthcare Effectiveness Data and Information Set (HEDIS) measures, other measures of timeliness, and indicators that individuals are served at the appropriate level of care  
• Tracking the amounts and types of service that lead to successful outcomes 
• Measuring productivity, value, and financial performance 

In addition, all interviewees wanted outcome measures that demonstrate that people are getting better, experiencing higher quality of life, and expressing satisfaction with services they receive. These may include resolution of functional impairments and condition-specific symptoms, client self-assessment of their own quality of life, and social indicators of success. Recent efforts like CHCF’s Cultivating Outcomes through Equity in Behavioral Telehealth (COE-BT) learning collaborative and the clubhouse model, pioneered by Fountain House (now a Medi-Cal option under BH-CONNECT), have demonstrated realistic approaches to implementing recovery-oriented outcome measures in behavioral health settings.  

Address Disparities with Better Demographic Data

Individual counties and the state as a whole have greatly increased their collection and reporting of demographic data as California increasingly focuses on equity in behavioral health care. However, lack of coordination among state departments and agencies ensures ongoing inconsistencies in data requirements. Different programs may break down race and ethnicity options differently. For instance, while some include only high-level categories, such as Hispanic and Asian, others have more specific requirements across orientations and identities. State agencies are working to align with updated demographic data guidelines from the federal Office of Management and Budget (OMB), but the current lack of consistency exacerbates existing administrative challenges to collecting data from clients.  

Upgrade Dashboards and Reporting

California has made progress when it comes to reporting data, and respondents cited improved public data dashboards from state agencies. Unfortunately, some of these dashboards are no longer relevant, and few cut across programs, making it difficult for stakeholders to get a comprehensive picture of state or local progress. What’s more, the process of getting data into reports and public dashboards is long and unwieldy, often taking months or even years for counties and the state to declare claims data to be final.  

Some large counties aren’t waiting for the state to act. Instead, they’re analyzing and reporting their own data. Some have developed sophisticated dashboards, which requires dedicated teams to collect, report, and analyze data — services that may be unavailable to small- and medium-sized counties. 

What’s Next

Some promising changes in behavioral health measurement and reporting are underway. One is the 2023 launch of a semi-statewide Electronic Health Record system for behavioral health providers by the California Mental Health Services Authority.  

As well, Medi-Cal’s recently adopted Behavioral Health Accountability Sets builds on the California Department of Health Care Services’ (DHCS’) long-standing Managed Care Accountability Sets and requires counties to report on nine different quality measures. And DHCS recently released its first set of behavioral health plan ratings (reporting 2023 performance) (PDF) using the new accountability sets.  

Finally, DHCS has convened a Behavioral Health Transformation Quality and Equity Advisory Committee (QEAC), which includes experts from across California’s public behavioral health system. (Editor’s note: Both authors serve on the QEAC.) Over the last six months, the QEAC has helped identify population-level behavioral health measures that reflect community well-being in domains including access to care and homelessness. The data gathered will inform counties’ BHSA planning and resource allocation processes. This effort is now entering its second phase, which involves measuring performance across delivery systems.  

But much remains to be done, including:  

• Developing and clearly communicating a consistent statewide strategy. Currently, quality and outcomes are defined at a program level, if they are defined at all. However, there is no consensus on what quality and success mean for behavioral health services statewide. Through Behavioral Health Transformation, the state has the opportunity to simplify, prioritize, and align performance.  
• Enabling counties and the state to share leadership roles in managing behavioral health data. Counties should be able to bring forward actionable data to help guide state policy, inform decisionmaking, and advocate for federal support to address California’s specific challenges. The state should also help counties understand how best to use data to guide those decisions.  
• Educating the public on how behavioral health services should work and how they interact with other health and social services programs. This includes using population health measures, such as education or employment, that demonstrate movement outside of the behavioral health system, rather than current data measures, which largely depict the way individuals move within the behavioral health system.  
• Focusing on recovery-oriented, strengths-based data that reflect clients’ values and their stories. Doing so improves our ability to measure what matters to people receiving services and what it means to help them improve the quality of their lives. California’s data efforts should pay special attention to the diverse voices of people receiving services to ensure that we measure what is important to them, use accessible language, and are culturally responsive. 

As California builds a behavioral health system that meets everyone’s needs, we can and should ensure our data demonstrate the impact of that work. 

Authors & Contributors

Catherine Teare

Associate Director, People-Centered Care

Learn more about Catherine Teare

Samantha Spangler, PhD

Owner and CEO, Behavioral Health Data Project

Samantha Spangler, PhD, is owner and CEO of Behavioral Health Data Project, a Sacramento-based consulting firm focused on helping behavioral health providers use data more effectively to understand and help the communities they serve. Spangler has evaluated behavioral health and social services programs at the state, county, and local level and supported behavioral health agencies to develop data collection and reporting systems that promote high quality, recovery-oriented, and equity-focused behavioral health services.

Hayne Palmour IV

Photojournalist

Hayne Palmour IV worked as a staff photographer for San Diego County newspapers for more than three decades, including eight years at the San Diego Union-Tribune. He covered news, features, and sports and continues working as a freelance photojournalist in Southern California.

In 2003, the North County Times published a book featuring Palmour’s photographs of the 2003 US invasion of Iraq titled A Thousand Miles to Baghdad.

He has an associate’s degree in photography from Chowan College in North Carolina and a BA in psychology from the University of North Carolina-Wilmington.

Link to Website

The post What Providers and Administrators Need from Behavioral Health Data Reforms appeared first on California Health Care Foundation.

Evanne Levin of Rancho Mirage has been struggling with a difficult question lately: What will she do if her 101-year-old mother loses her Medi-Cal coverage? 

Medi-Cal, California’s Medicaid program, allows Levin’s mother Rose to receive daily in-home caregiving through the In-Home Supportive Services (IHSS) program. That makes it possible for her to live at home despite mobility and memory challenges. Without that support, Levin, 75, who has her own health and financial difficulties, isn’t sure how she would cope. 

“I wish I had a good answer, an easy answer,” said Levin, who lives near her mother and helps care for her outside of the four hours a day covered by IHSS. “I cannot be there for her all the time. We would have to look at a facility that accepts Medi-Cal as payment, and if Medi-Cal was going to be cut back, it’s going to impact the facilities as well.” 

Across California, Medi-Cal enrollees and their loved ones have been wrestling with similar questions since the US House of Representatives adopted a federal budget resolution that sets the stage for significant cuts to Medicaid.  

Levin lives in the congressional district that stretches across Riverside County and includes the cities of Corona, Lake Elsinore, Menifee, Palm Springs, Palm Desert, Indian Wells, and portions of Eastvale and Riverside. Over 256,000 people — about 34% of the district’s population — are covered by Medi-Cal. 

The prospect of Medi-Cal cuts has alarmed patients, health care providers, advocates, and caregivers across the region. They fear the budget cuts will harm the working families, seniors, people with disabilities, and children who rely on the program; the providers and institutions that provide services to them; and the broader economy and community. An estimated $11.57 billion in Medi-Cal funding flowed into Riverside County in 2024, according to the UC Berkeley Labor Center. Almost $3 billion of it was to cover the cost of caring for enrollees in the district. That money does more than support providers, clinics, and hospitals; it makes its way to local businesses, households, and city and county tax revenues too.  

Struggling Rural Facilities

Jarrod McNaughton is CEO of the Inland Empire Health Plan, a Medi-Cal managed care plan that covers 1.5 million of the approximately 2 million Inland Empire residents enrolled in Medi-Cal. The plan employs 4,000 people, including case managers and community health workers, and contracts with around 9,000 health care providers, hundreds of clinics, and every hospital in San Bernardino and Riverside Counties.   

Big reductions in Medi-Cal spending would devastate patients, providers, and the local economy, McNaughton said. He’s especially worried about reduced Medi-Cal support for struggling rural facilities, which could be forced to make massive service cuts, or even close, he said. On average, Medi-Cal accounts for almost 20% of net patient revenue going to hospitals in the congressional district. At certain hospitals, it accounts for more than half.  

Other knock-on effects of Medicaid cuts could be that more people with chronic conditions flood hospital emergency departments because they can’t access preventive care, and fewer providers cover Medi-Cal patients because of lower reimbursement rates, McNaughton said. 

“You will see catastrophic patient outcomes from these kinds of cuts,” McNaughton said. “You’re going to see a strain on the system for everybody, regardless of whether you’re commercially covered, whether you’re covered by a government program like Medicare or any other program, because now you’re going to have an influx of patients into hospitals that are already going to be stretched so thin.” 

Community Clinics Brace for Significant Disruptions

Community clinics would be hurt too, said Andy Piskoulian, CEO of Centro Medico Community Clinic, a nonprofit community health center with five clinics in the Inland Empire, including ones in Corona and Riverside. The organization provides health care to approximately 15,000 patients in the congressional district, almost all of whom have Medi-Cal.  

If cuts happen, ancillary services such as dental, vision, and podiatry care could be the first to go, Piskoulian said. Patients could end up waiting months for medical appointments as staffing is reduced, he added. The clinic may also have to slash such programs as free transportation for seniors and acupuncture services that have helped reduce some patients’ needs for addictive pain medications. 

Piskoulian said he’s especially frustrated at the prospect of Medi-Cal cuts rolling back progress the center has made in reaching and helping more patients. In the past three years, Centro Medico opened a clinic at a homeless shelter in Corona that expedites the medical tests people need to get off the streets, opened a clinic in a remote desert community where people previously had to drive 30 miles to see a doctor, and began coordinating medical and social services for 800 high-needs patients under CalAIM. The organization also plans to open a resource center in Corona that will provide health classes, social services connections, after-school tutoring, job search help, and other services for area residents. 

“We’re like, oh my god, where are we going?” Piskoulian said. “Hopefully this beautiful model that I think would do an amazing service to the community doesn’t fall because of what’s about to happen.”  

Polling Finds Widespread Anxiety

Fear over potential Medicaid funding reductions is widespread: a recent poll by NORC at the University of Chicago found two-thirds of Californians are worried that enrollees will not be able to access the same level of benefits in the future. That same poll found broad support for Medi-Cal among Californians across party lines, with 8 out of 10 Democrats and nearly two-thirds of Republicans wanting the program to stay the same as it is today or receive additional funding.  

One of those expressing anxiety is Amie Cullop of Meniffee, a retired US Army sergeant who completed two tours of duty in Iraq and now fears that Medi-Cal cuts could make it harder to care for her son Miles. The six-year-old was born with a neuromuscular disease that affects his breathing, mobility, and endurance.  

Although Cullop has health insurance through the military, it doesn’t cover all of Miles’ therapies and out-of-pocket medical costs. Medi-Cal paid for the early intervention therapy that taught Miles to sit, eat, walk, and hold a pencil. It now covers occupational, physical, and speech therapies as well as adaptive equipment that allows him to do schoolwork, play the piano, and dream of becoming a pediatric pulmonologist.  

“I credit the services he has received to where he is,” Cullop said. “I don’t want to see other families struggling, other kids struggling, especially when I know the good these programs and the funding Medicaid provides can do.”  

Barriers to Mental Health Care

Linda Hart, founder and executive director of the African American Health Coalition, worries Medicaid cuts could make it even harder for people with mental health conditions to get treatment. Her organization works in Black communities across San Bernardino and Riverside Counties to provide mental health education and referrals.  

Hart’s adult son relies on Medi-Cal to pay for medications to control his schizophrenia and for services that enable him to access to stable housing. Without that support, Hart worries he and others with severe mental illness could become a risk to themselves or others and could put pressure on first responders.   

“It’s not just cutting someone off of Medi-Cal, it’s what are the ramifications of when that happens?” Hart said. “You may be thinking about saving money, but you’re going to lose lives.” 

At the Inland Caregiver Resource Center in Colton, staff are fielding constant questions from anxious seniors and their caregivers about what potential cuts to Medi-Cal could mean for them, Executive Director Carmen Estrada said. The center, which supports older adults and their family caregivers with counseling, respite, and housekeeping services, works with many people who receive In-Home Supportive Services.  

“A lot of the people we see, they’re just making it. Any cut could keep them from staying in the home where they want to be and [lead to them] being homeless or even institutionalized,” Estrada said. “It is definitely a scary time.” 

‘Personal and Emotional’

Scared is how Kristine, 68, of Desert Hot Springs feels. Since her husband died in 2018, she has relied on IHSS-paid home health aides to help her with daily tasks such as using the bathroom, preparing food, and going to doctors’ appointments. Kristine, who asked that her last name be withheld because she feels vulnerable, has a type of inflammatory arthritis that left her partially paralyzed and functionally blind.  

“I would literally be institutionalized [without IHSS] because I can’t care for myself and my care providers cannot work for free, and I have no family,” she said. “I don’t have someone that can step in that’s not paid to help me. It’s so personal and so emotional that I have a hard time languaging it.” 

Back in Rancho Mirage, Evanne Levin said she’s been closely monitoring the news about Medicaid funding coming out of Washington in between the hours she spends every day overseeing her mother’s care.  

“I think about all the people who don’t have a me to help them,” she said. “Our elders and those with disabilities should be treated with greater respect … I’m speaking for my mom and me, but I’m also speaking on behalf of all of those that don’t have their own voices.”  

Authors & Contributors

Claudia Boyd-Barrett

Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities. Her stories have appeared in the Los Angeles Times, San Francisco Chronicle, San Diego Union-Tribune, and California Health Report, among others.

Boyd-Barrett is a two-time USC Annenberg Center for Health Journalism fellow and a former Inter American Press Association fellow.

John Valenzuela

John Valenzuela, a seasoned freelance photographer and former staff photographer for Southern California News Group, captures stories through his lens.

The post In Riverside County, Potential Medi-Cal Cuts Distress Constituents, Health Leaders appeared first on California Health Care Foundation.

To improve the health and well-being of people experiencing homelessness and people returning to housing, CHCF has brought partners from the housing industry together with UC Berkeley housing innovation experts and experts in Medi-Cal policy. This is the kind of cross-sector collaboration needed to improve the health and housing outcomes of people experiencing homelessness. With support from the foundation, the Terner Center for Housing Innovation is facilitating a working group of affordable housing developers.

Together, these builders are learning how to use the CalAIM (California Advancing and Innovating Medi-Cal) initiative’s Community Supports program to ensure that residents who get into stable housing on their properties can remain there. The working group intends to achieve its goals by strengthening the integration of health care with housing.  

Recently, I talked with Carolina Reid, PhD, faculty research adviser at the Terner Center, about the housing crisis in California.  

Q: Expanding the supply of affordable housing is a critical need in California. How are developers approaching funding these projects?  

A: New buildings with affordable housing units are funded in lots of different ways. In some cases, the government provides a voucher that a person can use to pay their rent to a private landlord. Another way is by developing new public housing, but a 1998 federal law (PDF) makes it hard to construct new public housing units. Instead, developers use the Low-Income Housing Tax Credit (LIHTC) program.  

Historically, the LIHTC has primarily been used to build units for working families and seniors. Increasingly, it’s allowing developers to create permanent supportive housing (PSH) units for people experiencing homelessness. These are designed to help people with the most acute needs, including those who have experienced chronic homelessness or have a disability. This includes a permanent housing placement with supportive services to ensure they can stay housed, such as help with traveling to medical appointments, case management services, and mental health counseling.  

Q: Are those services delivered by the same organizations that build and manage affordable housing? 

A: It depends. Developers of affordable housing properties, including those that have units set aside for PSH, manage their properties differently. Some PSH developers contract all their services to organizations that specialize in case management or supportive services. Others hire their own staff and may provide dedicated case management or health care services. All PSH developers work to ensure that their residents get the services they need through one of these mechanisms. 

Q: In the health care sector, CalAIM promises to expand access to social supports for eligible Medi-Cal enrollees. Is the availability of Community Supports a strong incentive for affordable housing developers?  

A: One of the most important aspects of CalAIM is that eligible Medi-Cal members can get access to the Housing Tenancy and Sustaining Services Community Support. Unlocking Medi-Cal dollars for this would be transformative for developers of permanent supportive housing. While the state has prioritized building PSH units, there is not nearly enough financial support to ensure that residents, especially those who have been unhoused or homeless for a long time, can successfully live in an apartment building. The housing system doesn’t have enough resources to provide the level of care needed by residents who have experienced chronic homelessness or who have complex needs. This funding gap is reducing the quality of care that PSH residents receive. For example, one case manager may be working with 40 or 45 residents. That’s well above established best practices, which tend to be closer to 20 residents per manager.  

Another reason is that residents who aren’t getting the support they need are more likely to move out and return to homelessness, which undermines efforts to address California’s crisis.  

Q: Before CalAIM, how were supportive services financed?  

A: Developers have long had to cobble together funding from multiple sources to provide supportive services, and there have been important state programs focused specifically on certain populations. The Whole Person Care Pilot program and funding from the Mental Health Services Act were both important precursors to CalAIM.  

However, our research has shown that across the board, the field needs more investment to expand access to services and ensure the presence of a well-trained workforce that can meet people’s care needs. I know it can sometimes feel like we aren’t making progress, but the evidence shows that permanent supportive housing is an effective approach to ending chronic homelessness. I have talked to many PSH residents who say it has transformed their health and stabilized their families. That’s why we want to connect CalAIM with PSH services — because it works. And evidence shows that when we invest in housing and permanent supportive services, it improves people’s health and people stay housed long-term. 

Q: You’re now convening a working group of PSH providers to identify and overcome barriers to accessing CalAIM. What have you learned?  

A: Managed care plans tend to think of the housing supports under CalAIM as a short-term goal: An organization successfully provides housing navigation services and moves a member into permanent housing. Maybe they also authorize six months of tenancy sustaining services. Then, they assume the problem is solved and no longer needs support.  

But people often need episodic support throughout their time in permanent supportive housing. Tenancy sustaining services are almost never a ‘one and done’ situation. When a developer plans to build permanent supportive housing, they have to map out the financing of that property for 15 years. This includes not just maintenance of the property, but also the staffing needed to support residents over those years. A developer can’t plan for a long-term, on-site case manager if the managed care plan has to re-authorize case management services every six months.  

These Community Supports can be time limited or offered just once in a lifetime. Say the person successfully moves into the property, even for several years. Later they have a traumatic episode and need supportive services again. The managed care plan may be thinking, “We already provided six months of tenancy supportive services. We succeeded. Why should we authorize it again?” 

Another big challenge is that people are mobile, and housing units are not. A person might move into a unit and be eligible for tenancy sustaining supportive services, which the developer can then use to pay for staff. But if that person moves away, then the developer loses the funding that supports that unit and the property-level staff.  

Although there’s a lot of uncertainty and risk for a developer in counting on Medi-Cal funding to provide supportive services, developers are investing a lot of energy into figuring out these challenges because of the tremendous potential benefits of providing person-centered care at PSH properties.  

Q: What other barriers to accessing Community Supports have you heard about from the developers in the working group?  

A: They are already working within a fragmented regulatory and financing system. Every property that includes PSH units has multiple funding sources. That means navigating multiple sets of regulations and reporting requirements. Then you add CalAIM, which adds managed care plans and their regulations to the mix.  

In addition, many PSH developers work across multiple counties. Different counties have different managed care plans. That lack of standardization across plans is a huge implementation barrier. 

Another challenge is that the record keeping for affordable housing looks really different from the record keeping needed for billing Medi-Cal. PSH developers also have to make their data systems HIPAA-compliant, while Homeless Management Information Systems don’t integrate easily with managed care plan and Medi-Cal systems. These requirements add significant administrative costs at the front end, and not all developers can afford them. 

Q: Many of those challenges are similar to the ones described by community-based organizations and other non-traditional providers of Medi-Cal services. What approaches or potential solutions has the working group focused on?  

A: The first real goal of the working group has been to demystify CalAIM. It’s a whole new set of concepts and institutions, and there’s a lot of information sharing that’s needed. How are managed care plans organized? What are Community Supports? What things should an affordable housing developer consider as they decide whether to become a Community Supports provider? 

The second has been to share different models that PSH providers are using, and to talk through how CalAIM has changed organizations’ supportive services models. We’re lucky to have a few organizations participating who have been successful at connecting the dots between their residents and CalAIM. For example, some are becoming Community Supports providers for the wider community, not just residents living in their properties. That seems to be working particularly well in places where there may be less local capacity for providing Community Supports. 

This would be especially impactful outside of big urban areas with a lot of existing service organizations, such as rural areas and the Central Valley.  

Another emerging model is for developers to build Community Supports into their properties incrementally. Say a developer has a building with 100 units. If they were to commit to providing Community Supports to the residents of all those 100 PSH units, they would be exposing themselves to a lot of financial risk if they end up not getting reimbursed due to lack of eligibility or re-authorization denials. Instead, developers are being conservative by budgeting maybe 10% of their total units to CalAIM. That gives them enough funding to support one additional case manager, but if the CalAIM funding doesn’t come through, it’s not going to put the entire property at risk. 

Q: How important is it for managed care plans to have dedicated staff who understand not just homeless services, but also housing? 

A: Some plans have really embraced housing as a social determinant of health and have staff who are advancing innovative partnerships. But I think there is a need for all managed care plans to learn about housing systems and how they work. Housing is critical for health, and I only see it becoming a stronger partner for health care going forward. So, it is within managed care plans’ interests to develop a shared language with housing providers and lay the foundation for stronger collaboration between these sectors.  

We’re all going to benefit if we figure out how to bring these two complex and fragmented systems together and ensure that everyone gets the housing and services they need.

Authors & Contributors

Michelle Schneidermann

Director, People-Centered Care

Learn more about Michelle Schneidermann

Jungho Kim

Jungho Kim is an Oakland-based photographer. He takes photos from his perspective as part of the Korean-adoptee diaspora — forever an outsider in an insider’s world — and is heavily influenced by his experiences living in the US, Japan, Sweden, and Korea. His work has focused on revealing the stories of those exploring their identities, experiencing inequity, or learning to adapt to our changing climates.

During the COVID-19 pandemic he spent extensive time with unhoused people and organizations providing them with basic necessities and community support. Kim also covered dozens of protests during the Black Lives Matter protests following the killing of George Floyd, including direct actions like the toppling of statues in San Francisco’s Golden Gate Park. In 2019, he  documented the pro-democracy movement in Hong Kong, capturing quiet moments of resistance, defiant protesters, and violent crackdowns by police.

The post Housing Developers Leverage CalAIM for People Experiencing Homelessness appeared first on California Health Care Foundation.

View the Report

Medi-Cal, California’s Medicaid program, provides health coverage for Californians with low incomes, including children and their parents, pregnant women, seniors, people with disabilities, and adults under age 65. Medi-Cal is operated by the California Department of Health Care Services in partnership with the state’s 58 counties.

Medicaid was established in 1965, as part of the federal Social Security Amendments (SSA). Medicaid rules regarding who gets coverage and which benefits are included are determined by SSA requirements and implemented by the federal Centers for Medicare & Medicaid Services (CMS). Every state that participates in the Medicaid program must create a State Plan that describes the scope of its Medicaid program and must seek federal approval for that plan.

Waivers and State Plan Amendments

The law also permits CMS to waive certain aspects of the law to enable states to test different approaches to program eligibility, benefits, delivery systems, and financing. This is known as a waiver. The most common types of waivers include 1915(b) waivers, primarily used for authorizing managed care delivery systems, and 1115 demonstration waivers, primarily used to demonstrate experimental projects. Waivers are time-limited and may be ended, renewed, or extended by the state at CMS’s discretion.

When a state wants to substantially change how it operates its Medicaid program, it must apply to change its State Plan by submitting a State Plan Amendment (SPA) to CMS for approval. SPAs have no time limit and are in effect until either the state further amends the State Plan or federal changes necessitate an amendment.

Waivers and CalAIM

Medi-Cal is taking significant steps to advance more equitable, coordinated, and person-centered care that helps enrollees maximize their health and life trajectory. This transformative initiative, known as CalAIM (California Advancing and Innovating Medi-Cal), includes broad-based delivery system, program, and payment reforms across the Medi-Cal program.

To implement CalAIM, the Department of Health Care Services received needed federal authorities, including approval of California’s Medicaid State Plan, a Section 1915(b) waiver (PDF), and a Section 1115 demonstration waiver (PDF).

Three publications, about Medicaid SPAs, waivers, and their use to implement CalAIM, are available to download below.

Medi-Cal: A State-Federal Partnership provides an overview of how California and the federal government jointly administer and fund Medi-Cal.

Medi-Cal State Plan Amendments and Waivers Comparison Chart compares the federal processes and requirements for Medicaid SPAs and common waivers.

CalAIM Authorities Chart shows CalAIM initiatives and their enabling federal authorities.

The post Medi-Cal Waivers and State Plan Amendments appeared first on California Health Care Foundation.

Key takeaways

Street medicine providers are establishing innovative partnerships with Medi-Cal managed care plans to create funding streams that support their mission of delivering health care to unhoused Californians where they live.

Yet there are gaps in the current contracting relationships between managed care plans and street medicine providers that are impeding providers’ financial sustainability.

The brief provides recommendations for both street medicine providers and managed care plans to achieve more effective contracting.

Street medicine has been a small but growing part of the California health care landscape since the early 1990s, with providers delivering health and social services to people experiencing unsheltered homelessness in their own environment, tailored to meet their needs and circumstances. Funding for street medicine has traditionally relied on grants, donations, and funding from parent organizations (e.g., hospitals and brick-and-mortar clinics). These funding sources are often cobbled together from year to year, leaving street medicine programs with a great deal of uncertainty.

California has implemented new programs — beginning in 2022 through the CalAIM (California Advancing and Innovating Medi-Cal) initiative — and has enacted policy changes that offer opportunities for street medicine providers to become part of the Medi-Cal managed care environment. Contracts with Medi-Cal managed care plans have the potential to provide more financial sustainability for providers.

This issue brief, Enhancing Financial Sustainability for Street Medicine: Examining Medi-Cal Managed Care Contracts with California Providers (PDF), provides a snapshot of contracting efforts between a sample of managed care plans and street medicine providers in the summer of 2024 and the impact that those contracts are having on the financial sustainability of street medicine providers. In addition, a statewide survey of street medicine providers was conducted in November and December 2024 to document the status of this type of contracting across the state. Both the brief and the survey were produced by researchers at California Health Policy Strategies.

Authors & Contributors

Gretchen Schroeder

California Health Policy Strategies

David Panush

David Panush, president of Sacramento-based California Health Policy Strategies, is working with the California Health Care Foundation to improve the linkage to health care for people returning to the community from jail and prison. Panush spent 35 years in state government, where he gained a unique understanding of policy, politics, state budget issues, and the inner workings of the legislative process. He was part of the core senior leadership team responsible for launching and managing Covered California, the state’s health benefit exchange.

Jane Ogle

California Health Policy Strategies

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