New MCP toolkit helps plans engage members with complex needs in program design
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With federal legislation and California’s budget shortfall putting increased budget pressure on Medi-Cal, state policymakers are going to face hard decisions about how to deploy limited resources. A new brief from ATI Advisory explores the potential harms of one of the simplest solutions — reducing services. This brief shows how cuts to optional Medicaid benefits like home and community-based services (HCBS) could actually end up raising costs for the state.
Kate Meyers, MPP,
Senior Program Officer,
People-Centered Care
The ATI analysis found a 10% cut to five key HCBS programs, which help older adults and people with disabilities stay in their homes rather than moving to nursing facilities, could result in a state net spending increase of more than $1.1 billion over the next five years, due to increases in nursing facility use. Cuts of this magnitude could also overwhelm nursing facility capacity, leaving many Californians without access to either home-based supports or nursing facility care.
Highlights
New toolkit: Helping managed care plans engage members with complex needs to build successful programs
A new step-by-step guide for managed care plans offers tips for crafting member engagement strategies to develop successful programs for people with complex needs.
Certification opportunity: Medical respite programs can apply for certification in November
A CHCF blog and fact sheet explore the growing success of medical respite programs, which are now eligible for certification through the National Institute for Medical Respite Care.
Fact sheet series: The experiences of people CalAIM aspires to serve
The next two fact sheets in CHCF’s Listening to Californians with Complex Needs series focus on people who need support to live independently and who are transitioning from incarceration.
New toolkit: Helping managed care plans engage members with complex needs to build successful programs
It happens too often in program design: Managed care plans implement an ambitious new initiative to improve services or increase supports for a key group of their members, only to discover that the members who would benefit most don’t participate.
There’s often a simple reason behind this unexpected conundrum: When plans view populations with complex care needs as “hard to engage,” it is often because programs have not been designed from the members’ perspective.
A new toolkit developed by a former Medi-Cal managed care plan director offers a step-by-step guide to help plans rethink and reorganize how they involve people with lived experience in the design and management of their programs — a key step toward developing successful CalAIM initiatives. The toolkit starts with three key questions that plans should consider asking themselves: How much influence will they invite members to have? When will their projects invite members in? How will they avoid causing harm — or leaving their members feeling used, unseen, or undervalued?
The toolkit includes a 10-step plan for crafting successful engagement activities, with case studies on recruiting members with lived experience and turning their insights into long-term, actionable solutions.
See the full toolkit:
Certification opportunity:
Medical respite programs can apply for new certification in November
Without a safe place to heal, people experiencing homelessness often cycle repeatedly through ERs and hospitals, driving up costs and straining the health care system, while leaving their underlying health and housing needs unaddressed.
A CHCF article showcases how medical respite programs are breaking this cycle by serving as the missing link between hospital discharge and stable recovery — providing access to temporary housing and medical care when people are too sick or frail to heal on the street or in shelters. Research shows the cost savings can be significant: Every dollar invested in medical respite programs translates to $1.81 in cost savings, along with significantly fewer emergency room visits and hospital readmissions.
In November, a new certification for medical respite programs will begin accepting its next wave of applications — giving more programs an opportunity to demonstrate they can meet nationally recognized standards for providing high-quality care. The National Institute for Medical Respite Care piloted the program in 2023 and 2024 and certified 15 facilities across the country, including four in California. After an official launch earlier this year, another 20 medical respite programs are now working toward certification, which can improve service delivery and streamline hospital and plan assessments — accelerating program approvals and payment.
Medical Respite Resources:
- Learn more about certification on the NIMRC Certification for Medical Respite Programs.
- Read the CHCF article New Certification Offers Support, Credibility for Medical Respite Care Programs.
- Check out the fact sheet: Medical Respite: A Cost-Effective Solution for Californians Experiencing Homelessness.
Fact sheet series: The experiences of people CalAIM aspires to serve
The next fact sheets from CHCF’s Listening to Californians with Complex Needs project were published this month. They highlight how specific populations that CalAIM seeks to serve are experiencing their care.
This first fact sheet focuses on people who need support to live independently. More than one in three older adults says they prefer to live at home or receive community-based services, even when managing physical challenges or cognitive decline. Many of these adults depend on caregivers for transportation to medical appointments and emphasize the need for increasing reimbursed caregiver hours, along with more financial support to cover the cost of medications, groceries, and travel.
The second fact sheet highlights the experiences of Californians transitioning from incarceration, who face many urgent social and health care needs upon release, including housing, financial support, employment, and mental health and substance use treatment. Yet three in four people returning from incarceration who have behavioral health issues report challenges getting treatment, and nearly half report inadequate housing support. Many reported rude or hostile attitudes from providers, and some feared they would be sent back to jail if they fully disclosed the nature of their substance use issues. Empathetic care managers, particularly those with lived experience, are integral to their success.
Read the fact sheets, which include resources for providers:
Check out the full report:
Other CalAIM Articles and Resources We Recommend
- Visit CHCF’s website to see our resources on medical respite.
- Case Study: Saving Lives and Resources at New Rural Sobering Center in Butte County (HC2 Strategies)
New Research Highlights Pair Team's Novel Approach to Improving Medicaid: Better Engagement, Lower Costs and Improved Health Outcomes (PR Newswire)
Results include 52% fewer ED visits, 26% fewer hospitalizations, and improved behavioral health outcomes.
Medi-Medi plans (aka D-SNPs) will be available in 41 counties starting in 2026. (DHCS)
Effective January 1, Medi-Medi plans will be available in 41 counties across California, up from 12 today. Although the Medicare enrollment deadline is December 7, California's dually eligible enrollees can enroll in a Medi-Medi Plan in any month of the year.
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