Despite the challenges, it’s extremely worthwhile for aging services organizations to apply for PATH CITED state funding, a critical fuel for the success of Medi-Cal’s innovative expansion – and a potential boost for the future of the organizations themselves.
There are three main reasons why robust participation by these organizations is so important to successfully implementing the CalAIM initiative to transform Medi-Cal:
- Aging services organizations have a unique role to play in the effort.
- Improving California’s version of Medicaid is crucial to reducing health disparities among older adults.
- Improving access to both health care and social services will yield better health and well-being for more than a million older Californians.
The core of CalAIM, a five-year initiative launched last year, is integrating social services into Medi-Cal, especially for those with the most complex conditions and social needs. To that end, the program’s main goals are:
- identifying and managing comprehensive needs through whole person care approaches and social drivers of health;
- improving the quality of outcomes;
- reducing health disparities, and transforming the delivery system through value‑based initiatives, modernization, and payment reform; and
- making Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility.
The effort is designed to improve the coordination of care for people facing the most complex health challenges while realizing a once-in-a-generation opportunity to improve the lives of 15 million Californians.
PATH CITED Enhances Care Management
Under the new system, Medi-Cal beneficiaries will be enrolled in managed care plans. Those eligible for both Medicare and Medi-Cal (including 1.2 million older people) will be able to select a plan that coordinates both sets of benefits. Those who qualify – including many older beneficiaries – will be offered enhanced care management and an array of community supports through community-based organizations under contract with a plan.
Enhanced care management is the coordination of social services and medical care that is community-based, interdisciplinary, high-touch and person-centered for people with the most complex medical and social needs.
It is critical to improving care for older people. And the 14 types of services to be offered include several things particularly important to older persons: medically tailored home-delivered meals, respite for caregivers, home modifications, and help in moving to more appropriate housing or back home from a nursing facility.
These new benefits can be an important source of new funding for community groups that provide supportive services, especially those that can prevent or delay nursing home placement. And PATH CITED has been created to help get those groups: $1 billion in grants to help community support service providers build capacity to participate in the new system. Money from Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion and Development (CITED) grants may be spent to hire and train staff, purchase new information technology systems, and otherwise get ready to be part of CalAIM. Those eligible include community-based organizations, county, city, and other local government agencies, and providers including hospitals and provider organizations.
Community-based Organizations Have a Critical Role to Play in CalAIM
Aging services organizations are uniquely positioned to get involved. They have expertise in a range of services including home-based care, nutrition support, and transportation assistance. So by partnering with managed care plans and other providers, they can play a vital role in improving the overall quality of care for Medi-Cal beneficiaries.
Because Medi-Cal is the nation’s largest provider of health insurance coverage for low-income individuals and families, it has enormous power to shrink the health disparities they face. And CalAIM holds great promise for reducing those inequities and creating more equalized access to high-quality care.
For older Californians especially, the need to address the current social injustice is profound. Fully 44 percent of those who qualify for both Medicare and Medi-Cal are in fair or poor health. And such conditions as diabetes, heart disease, and dementia disproportionately affect the state’s Black and Latinx populations.
These disparities are compounded by such social determinants of health as inadequate housing, limited access to health care and food insecurity. (Almost half of older people eligible for both Medi-Cal and Medicare, for example, don’t have consistent access to a sufficient and healthy diet.) These challenges increase rates of chronic disease and reduce quality of life.
At Archstone Foundation, we are realistic in our thinking and acknowledge upfront the challenges and considerations organizations must face before deciding to become part of CalAIM. Payments are based on beneficiaries served, not fee-for-service, so organizations must be sure those payments will cover their costs. Developing relationships with health plans takes time and can be complicated. And the Medi-Cal system is complex, including the billing and reporting requirements.
Nonetheless, at a recent webinar we hosted with The SCAN Foundation, leaders from two aging services organizations – Alzheimer’s Los Angeles and the Dayle McIntosh Center for the Disabled in Anaheim – spoke enthusiastically about participation in CalAIM expanding their reach, offering important and needed services that improve the health and well-being of their clients, and making their income streams more sustainable. (You can watch the webinar here.)
They are powerful examples of why more and more such organizations are pursuing participation in CalAIM. Obtaining a PATH CITED grant is the best way to prepare for that move – and aging service organizations are encouraged to apply for the next round of funding by May 31.
