March 23, 2023

A Monthly Digest of Information and Resources on California’s Efforts to Transform the Medi-Cal Program

Needless to say, it’s been a hard winter, and for too many people, it’s been disastrous. I hope you and yours are making your way safely through the ongoing atmospheric rivers and blizzards. Rolling out CalAIM changes has been made even more difficult with massive snowdrifts, pouring rain, and power outages. And yet, the people who you are all serving — especially those experiencing homelessness — are challenged all the more. Thank you for your hard work. 

— Melora Simon

Highlights

Perspectives from the field: developing the Enhanced Care Management workforce

As demand grows for the highly skilled workers needed to provide new Enhanced Care Management (ECM) services, a new CHCF report details how organizations are seeking to hire, retain, and train ECM providers.

Moving long-term services and supports into managed care — lessons learned and policy options

With managed care plans taking on responsibilities for programs that help people who need support with activities of daily living, a new CHCF paper shares lessons learned from past efforts as well as design options for increasing accountability, reducing inequities across services, and improving system navigation.

An opportunity for CalAIM? Expanding on health and housing partnerships that started during the pandemic

At the start of the pandemic, health clinics formed creative partnerships with transitional housing sites to deliver care to people who had been unhoused. Today these programs face long-term funding challenges. A recent CHCF blog post shares stories of people who benefited from these partnerships — and invites questions about the potential for these programs to be supported through CalAIM.

Perspectives from the Field: Developing the Enhanced Care Management Workforce

CalAIM’s Enhanced Care Management benefit requires a significant expansion of the care coordination workforce to provide intensive support to 10 “populations of focus,” from people experiencing homelessness or serious mental health issues to people transitioning from incarceration.

A new CHCF report from the Camden Coalition examines how organizations are working to both recruit and retain workers who can handle this complex job. Based on interviews with more than a dozen frontline care managers, the report found hiring and retaining sufficient staff has become many organizations’ top priority — with 70% of respondents in one focus group saying hiring is now their biggest challenge. The report also highlights some of the successful training approaches and tools that providers have adopted to train new employees, including expansive onboarding training modules, and mandated lessons on issues like psychosis and suicidality.

ECM providers also share recommendations for addressing their short-term needs (expanded peer-to-peer learning opportunities, for example), as well as some long-term keys to success, including workforce development funding and a statewide set of ECM workforce standards that will streamline hiring and staffing in the years ahead.

>> Read the CHCF report Perspectives from the Field: Developing the Enhanced Care Management Workforce. Also available with the report is a compilation of resources to help plans and ECM providers find training options related to ECM services and populations of focus.

 >>A new CHCF blog post, “Tech Start-up Dives into Medi-Cal Enhanced Care Management,” highlights the potential of Pair Team, a new start-up. Pair Team provides ready-to-go virtual and on-the-ground case management teams for providers and plans that aren’t staffing up their ECM workforce in-house.

Moving Some Long-Term Services and Supports into Managed Care — Lessons Learned and Policy Options

Millions of older adults and people with disabilities receive long-term services and supports (LTSS) for a range of daily activities, from bathing, dressing, and eating to transportation and housekeeping. While a patchwork of programs have helped provide these services for decades, CalAIM seeks to make them more consistent — and accessible — across the state by shifting responsibility for some LTSS to Medi-Cal managed care plans.

This health plan–based system is called Managed Long-Term Services and Supports (MLTSS). While the transition to MLTSS won’t be complete until 2027, the shift to a greater role for managed care in LTSS has already begun, including the option since 2022 for plans to provide Community Supports, and the requirement that plans statewide assume responsibility for care in nursing homes as of January 2023.

A new CHCF report offers some timely insights about the state’s ongoing options and potential next steps for shifting LTSS programs into managed care. While the Department of Health Care Services has stated its intent to keep the largest LTSS program — In-Home Supportive Services — out of managed care for the foreseeable future, there are many other potential services that could be folded into the new MLTSS. As stakeholders consider what MLTSS can and should look like, the CHCF report highlights lessons learned from past efforts to blend LTSS and managed care — along with how MLTSS could help address some of the challenges of today’s LTSS system. The report also details options for designing this program to increase accountability and oversight, reduce disparities across services, streamline enrollment and assessment, improve system navigation and care transitions, and strengthen data exchange.

>> Read the full CHCF report, Medi-Cal Managed Care and Long-Term Services and Supports: Opportunities and Considerations Under CalAIM.

>>California Collaborative for Long-Term Services and Supports and partners are launching listening sessions for LTSS providers to share challenges and successes in CalAIM implementation, and to develop strategies for improvement. Sessions will take place the last Thursday of each month, starting March 30. Sign up to participate.

An Opportunity for CalAIM? Expanding on Health and Housing Partnerships That Started During the Pandemic

On a recent morning, Refugio Lopez, 58, limped into a room at Orchid, the transitional housing facility in Hollywood where he lives, looking to see a medical provider. With a knee injury and other health problems stemming from diabetes, walking just over a mile to the nearest community health center is not really an option — while he dismisses calling his insurance provider or the clinic to arrange a ride as a “hassle.”

Luckily for Lopez and about 39 other formerly unhoused people who now reside at Orchid, the nearby clinic — Saban Community Clinic’s Hollywood Health Center — now comes to them. Twice a month, a three-person team staffed by a physician assistant, medical assistant, and patient navigator offers Orchid residents a range of free medical services, from general checkups and cancer screenings to vaccinations and disease management. “You don’t have to go anywhere; they’re right here,” said Lopez. “They help me with everything. It’s a blessing.”

A new CHCF blog post highlights how Lopez and many other LA residents are benefiting from new partnerships between health care and housing providers, many of which were developed during the pandemic to provide emergency services and to prevent COVID outbreaks among people experiencing homelessness. “One of the big gifts of COVID-19 was all the connection and networking we had to make to really provide the safety net” for people experiencing homelessness, says Shannon Fernando, the chief innovations officer for Los Angeles Christian Health Centers.

While short-term grant funding — through the Health Pathways Expansion grants — got the programs up and running, they have clearly demonstrated their value, providing community and critical preventive services to vulnerable groups. The next big question, of course, is how to make these programs financially sustainable without grant funding — potentially under the auspices of CalAIM. There is certainly no shortage of local support: “This is a necessary strategy to save lives and build trust among a highly vulnerable population,” Supervisor Hilda L. Solis said recently about LA’s expanding mobile care teams.

“When I was homeless, I didn’t take care of myself,” Lopez acknowledges. “In the streets I knew how to survive, how to get food, a hygiene kit, blankets, and all that, but I was just surviving. Now I can take care of myself.”

Programs like the one at Orchid have the potential to help many others do the same.

>> Read the full blog: “Clinics Follow Health Pathways to Reach the Unhoused.” Details are also available on the successful short-term grant program Health Pathways Expansion that has helped fund LA’s mobile health clinics.

Other CalAIM Articles and Resources We Recommend

• A little-known aspect of CalAIM standardizes which benefits are in — and out — of managed care across the state. An article last week from California Healthline/KHN, “Sacramento and Solano Counties Square Off with State over Mental Health Duties,” highlights the challenges of transitioning care, especially for people with complex needs. It also brings into focus the complexity of Medi-Cal financing and the reliance on local funding to support many Medi-Cal services. With economic uncertainty on the horizon, how we ensure equitable access to care looms large.
   
• Policy Brief: Understanding California’s Recent Behavioral Health Reform Efforts (PDF) (California Health and Human Services)
   
• Formerly Homeless Woman Moves into New Apartment with Help from Local Organization (10News.com)
   
• Addressing Intimate Partner Violence Through the CalAIM Population Health Management Program (Blue Shield of California Foundation)
   
• CalOptima Health Awards $29.9 Million in Grants to Boost Services for Orange County’s Homeless (Orange County Breeze)
   
• LA Care Health Plan CEO Offers Updates on California's Medicaid Transformation Ambitions (Modern Healthcare — paywall)

• Webinar: CMS Opens Door for Pre-release Services for Justice-Involved Populations: Health Care and Justice System Implications (Center for Health Care Strategies; Monday, March 27)
   
• Webinar: Medicaid Authority and Opportunity to Build New Programs for Justice-Involved Individuals (Health Management Associates; Thursday, April 6)

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