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.

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.

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

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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.

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.

Cynde Soto, a quadriplegic who requires around-the-clock care, has been on Medi-Cal for most of her life. Recently, she came into a modest inheritance, about $8,000, that has helped cover her daily expenses. But it also means that she would lose her state health insurance under a proposal from Gov. Gavin Newsom.

Newsom has proposed restoring a $2,000 limit on an individual’s assets — including savings accounts and property other than a home and a car — and $3,000 for couples to qualify for Medi-Cal. Anyone 65 and older or disabled who exceeds that limit would be ineligible. Newsom also is proposing a cap on how much home care Medi-Cal enrollees like Soto could receive.

In unveiling the proposal, Newsom said that California has a “spending problem” and needs to make “difficult choices” to address the state’s $12 billion deficit, which he attributed in part to growing Medi-Cal costs. His proposal would save the state $94 million this budget year and more than $500 million the next year, according to the governor’s budget document.

But health advocates say that it’s almost impossible for someone to live with just $2,000 in assets in California. Rent often exceeds that amount, and medical expenses not covered by insurance quickly add up.

Advocates say Newsom’s proposal unfairly targets people with disabilities and the elderly — those who are most likely to need full-time care and have fixed incomes.

“It’s draconian — $2,000 is no safety net for people,” said Kim Selfon, an attorney with Bet Tzedek, a legal services organization in Los Angeles.

For Soto, a Medi-Cal limit on assets would mean she would either lose the caretakers who help her bathe and eat or have to spend all of the money except for $2,000. With the inheritance, Soto said she can afford repairs to her Long Beach condo and buy medical supplies that Medi-Cal doesn’t cover, such as bandages or nutritional drinks to supplement her diet.

“It’s not cheap being disabled,” Soto said. “I’m really scared. I cannot live without my help.”

When Asset Limits Were Lifted, Medi-Cal Enrollment Surged

Some lawmakers and disability advocates have argued against the asset limit for years. They say it forces people into poverty and hasn’t kept up with rising inflation and cost of living. 

Newsom agreed to raise the limit to $130,000 per person in 2022. Then in 2024, the limit was erased completely. Now Newsom wants to bring back the original limit of $2,000, an amount that was set in 1989. 

This would reinstate complex rules about wealth and property that kept thousands of seniors and disabled people from qualifying for Medi-Cal. Under those rules, an individual’s first home and car are exempt, but other properties count toward the $2,000 limit. The balance of a 401k or retirement account are exempt, although payouts are considered income. Life insurance, cash on hand and savings accounts also count towards the limit. Even certain types of funeral plots count. 

The test would apply only to people 65 and older as well as those with disabilities, which creates a financial cliff for those about to turn 65. Medicare, which many seniors use for health insurance, does not cover long-term care and requires some co-pays, so many people use Medi-Cal to supplement their Medicare benefits.

In a recent Assembly hearing, Newsom administration officials said when the limit was eliminated, far more people enrolled in Medi-Cal than anticipated, contributing to the state’s growing costs. Between 112,000 to 115,000 people enrolled compared to early estimates of just 40,000, said health care services director Michelle Baass.

Seniors make up a small portion of all Medi-Cal enrollees, but they’re about twice as expensive as the average enrollee because they use more medical care. The elimination of the asset test last year contributed to most of the senior enrollment growth and cost the state about $500 million more than expected, according to a report by the nonpartisan Legislative Analyst’s Office. 

Still, lawmakers during the hearing questioned the prudence of kicking seniors and people with disabilities off of the program and whether it would actually save money in the long run. 

Assemblymember Pilar Schiavo, a Democrat from Santa Clarita, said these groups would need more expensive care like nursing home stays or homeless services if the asset test were reinstated.

“This is going to lead to more homelessness of seniors and the disabled. That’s what’s going to happen, and that will cost our state money too,” Schiavo said.

Making It ‘More Expensive to Age in California’

Al Sanderson, one of Selfon’s clients, says that’s exactly what would happen to him. The Redondo Beach resident broke his neck three years ago in a surfing accident that left him paralyzed.  

Sanderson said his monthly rent costs more than the asset limit. He has significant savings as a former high school physical education teacher and baseball coach that he uses to pay for utilities, transportation and things that his kids need now that he no longer works. 

If he got kicked off of Medi-Cal and lost his caretakers, Sanderson said he would lose his independence.

“How am I going to pay people to come help me? How am I supposed to survive and live? I’d have to go to a nursing home,” Sanderson said.

Without full-time home care, both Sanderson and Soto would most likely end up in nursing homes, a more expensive option that is covered by Medi-Cal. The state pays on average more than $114,000 per person each year for nursing home care, according to Justice in Aging, which pushed for the elimination of the asset test. In contrast, the average annual cost of in-home care is less than a quarter of that, $25,400 a year.

Kevin Prindiville, executive director of Justice in Aging, said Newsom’s proposal would “make it more expensive to age in California.”

California’s elimination of the asset test came under fire this month from congressional Republicans, who claimed that it allows the “wealthiest Californians” to get free health care. But lawyers with legal aid organizations that help people enroll in Medi-Cal say that’s not happening. 

Regardless of their assets, Medi-Cal enrollees still need to meet income limits, which are currently 138% of the federal poverty level, or about $1,800 per month, said Linda Nguy, a lobbyist with the Western Center on Law and Poverty. 

“Our clients are not millionaires,” Nguy said. “We’re talking about people with very low incomes who aren’t able to access the health care services that they need.”

Ronald Dallatorre, 58, enrolled in Medi-Cal just two months ago. He had been looking forward to getting caretakers to help him at his Compton home so that his wife could take a break. 

Dallatorre got sick with COVID-19 in April 2020. He spent four weeks on a ventilator and almost a year in a hospital. Now the former heavy duty mechanic has Guillan-Barré syndrome, an autoimmune disease that attacks the nervous system, causing muscle weakness and numbness.

Dallatorre uses a wheelchair and can’t move his hands. His wife quit her job with L.A. Unified School District to take care of him full-time. The Dallatorres also own a second home that a close family friend lives in, rent-free. Under the proposed budget, Dallatorre would be ineligible for Medi-Cal because of this property.

If he is kicked off Medi-Cal because of the asset test, Dallatorre said his medical costs would still be covered through his wife’s insurance, but they can’t afford caretakers. His wife would have to continue as his full-time support.

“I worked 40 years of my life never receiving help, always paying taxes. I was glad to do it because I thought maybe when I need it, somebody will be able to help me,” Dallatorre said. “I didn’t know how stupid the system is.”

This article was first published by CalMatters on May 29, 2025.

Authors & Contributors

Kristen Hwang, MJ, MPH

Reporter, CalMatters

Kristen Hwang reports on health care and policy for CalMatters. She is passionate about humanizing data-driven stories and examining the intersection of public health and social justice.

Prior to joining CalMatters, Kristen earned a master’s degree in journalism and a master’s degree in public health from UC Berkeley, where she researched water quality in the Central Valley. She previously worked as a beat reporter for The Desert Sun and a stringer for The New York Times California COVID-19 team.

https://calmatters.org/

The post ‘I’m Really Scared’: Elderly and Disabled Californians With More Than $2,000 Could Lose Medi-Cal 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.

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.

During the COVID-19 pandemic, states received increased Medicaid funding on the condition that they would postpone disenrollments as long as the federal COVID-19 public health emergency (PHE) remained in effect. This “continuous coverage” requirement allowed millions of Californians to stay on Medi-Cal during an unprecedented health crisis.

The federal Consolidated Appropriations Act of 2023 specified that the Medicaid continuous coverage requirement would no longer be linked to the PHE. The requirement ended on March 31, 2023.

Medi-Cal resumed its normal renewal processes on April 1, 2023. From that start date, it has 14 months to redetermine eligibility for around 15 million current enrollees. It’s estimated that during this “unwinding period,” two to three million Californians may leave the program. The vast majority will be eligible for other types of coverage but may need help transitioning. Many Californians who remain eligible for Medi-Cal are at risk of getting disenrolled from the program simply due to administrative or procedural barriers, such as Medi-Cal eligibility offices lacking enrollees’ current addresses after the last two tumultuous years.

This collection highlights recommendations and tools to help the state and key partners navigate the unwinding period while minimizing disruptions to Californians’ access to care and coverage.

In addition to the resources below, see Covered California’s Auto Enrollment Toolkit (available under “Medi-Cal Transition”). Soon after the federal continuous coverage requirement ends, Covered California will begin automatically notifying and completing plan selection for Californians who lose Medi-Cal coverage if they are eligible for a subsidized plan on Covered California. The toolkit provides more information for consumers and enrollment partners.

Featured Resources

Expert Perspective

State Works to Increase Access to Medi-Cal As Millions Seek Enrollment Renewal

From the front lines of eligibility redetermination, a California Department of Health Care Services official shares insights and recommendations.

January 4, 2024

Medi-Cal

Key Takeaways from Medi-Cal Redetermination Data

August 14, 2024

Medi-Cal

Efforts to Improve Medi-Cal Enrollment Process Are Paying Off

February 29, 2024

Health Insurance Coverage

How to Improve Medi-Cal Enrollment Renewals for Millions

December 6, 2023

Health Equity

DHCS: ​​​Keep Your Medi-Cal​

May 31, 2022

Expert Perspective

Medi-Cal Enrollees: Here’s How to Verify Your Eligibility

California’s safety-net health program has resumed annual eligibility checks after three years. That means enrollees will need to provide updated personal information to maintain coverage. Here’s what to watch for.

May 8, 2023

Medi-Cal

Health Consumer Alliance Keep Your Coverage Resource Page

April 5, 2025

Renew Your Medi-Cal Online with BenefitsCal

November 30, 2023

Thousands of Californians are losing Medi-Cal every month. What to do if you lose coverage.

September 25, 2023

Kaiser Family Foundation Medicaid Enrollment and Unwinding Tracker

November 30, 2023

Tool

Medi-Cal Renewal for People Experiencing Homelessness: Toolkit

This toolkit equips service providers, people experiencing homelessness, health enrollment navigators, and communities with the resources to keep current Medi-Cal members covered. It is available in English and Spanish.

September 14, 2023

Homelessness

State Health and Value Strategies: Resources for States on Unwinding

November 30, 2023

Communicating to Medi-Cal Members About the Unwinding

June 21, 2023

Medi-Cal

Op-Ed: Preserving Health Coverage for Millions of Californians Requires All of Us

September 18, 2023

​​​​​​​​​​​Medi-Cal ​​Continuous Coverage Unwinding Dashboard

August 24, 2023

Expert Perspective

Medicaid’s Continuous Coverage Requirement Is Over. What’s Next for California?

Using best policies and practices, California has the opportunity to ensure that the Medi-Cal eligibility and enrollment system always prioritizes keeping people covered.

April 5, 2023

Medi-Cal

DHCS: Medi-Cal COVID-19 PHE and Continous Coverage Operational Unwinding Plan

June 14, 2022

DHCS: ​​​​​​​​​​​​​​​​​​​Keeping Medi-Cal Beneficiaries Covered

May 27, 2022

CMS: Unwinding and Returning to Regular Operations After COVID-19

May 31, 2022

The post Medi-Cal and the End of the Federal Continuous Coverage Requirement appeared first on California Health Care Foundation.

Fast Facts

• According to research published in the Journal of the American Medical Association, phone visits constituted almost half of all primary care visits and more than 60% of behavioral health visits during the first six months of the pandemic at 40 California Federally Qualified Health Centers participating in the California Health Care Foundation’s COVID-19 telehealth initiative.
• Data from the same initiative suggest that phone visits may be an easier option for patients with limited English proficiency, who account for only 16% of patients who have received a video visit, but 26% of patients who have received a phone visit and 25% of those who have had in-person care.
• A survey of Californians who received health care between March 2019 and August 2020 found that more than a third of respondents (38%) had received a phone visit, and 72% said they were just as, or more, satisfied with their phone visit compared to their last in-person visit.
• The same survey found high utilization of, and satisfaction with, phone visits specifically among those with low incomes and among people of color:
  • 46% of respondents of color had received a phone visit.
  • 64% of respondents of color who had received a phone or video visit said they’d likely choose a phone or video visit over an in-person visit in the future.
  • 43% of respondents with low incomes had received a phone visit.
  • 63% of respondents with low incomes who had received a phone or video visit said they would likely choose a phone or video visit over an in-person visit in the future.

Explore the resources below to learn more.

Feature Story

Ending Phone Visits Would Be a Setback for Patients with Low Incomes

The director of CHCF’s Improving Access team says we should build on what is working well to improve access to care, especially for those whose needs have historically not been well served by the health care system.

April 30, 2021

The Doctor Will Call Me Maybe

March 9, 2021

Technology and Innovation

Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic

February 8, 2021

The post The Importance of Health Care Phone Visits 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.

View the Report

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.

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.

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.

The post Enhancing Financial Sustainability for Street Medicine: Examining Medi-Cal Managed Care Contracts with California Providers 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

The post Enhancing Financial Sustainability for Street Medicine: Examining Medi-Cal Managed Care Contracts with California Providers appeared first on California Health Care Foundation.

Regular participants in the community of practice include the following:

• MidPen Housing
• Jamboree
• SAHA
• Linc Housing
• Homeward Bound of Marin
• RH Community Builders
• EAH Housing

The community of practice features two key components.

• Education and peer learning for housing developers
  • CalAIM 101. Providing clear explanations of CalAIM and Medicaid waivers
  • State policy environment. Clarifying guidance, requirements, and interagency alignment about permanent supportive housing
  • Service contracting models. Sharing diverse approaches to structuring supportive services, and describing the benefits and challenges of each approach
• Addressing CalAIM implementation barriers in supportive housing
  • Identifying challenges through peer-to-peer engagement
  • Creating resources to explain issues and highlight solutions
  • Focusing on areas including client eligibility, care coordination, infrastructure, funding, and accountability

This initiative reflects CHCF’s commitment to data-driven solutions and cross-sector partnerships. By fostering a shared understanding between health care and housing sectors, the foundation seeks to improve the effectiveness of CalAIM’s housing supports and ultimately enhance care for Californians experiencing homelessness.

The post Bridging the Gap: Aligning Supportive Housing and Health Care Under CalAIM appeared first on California Health Care Foundation.