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CalAIM Community Supports: Promoting Independent Living Among Older Adults and People with Disabilities

April 26, 2022

Through CalAIM (California Advancing and Innovating Medi-Cal), a multiyear initiative to transform the Medi-Cal program, managed care plans now have the option to offer any of 14 Community Supports that provide person-centered services to address a variety of social drivers of health. Several of these Community Supports could help older adults and people with disabilities remain in their own homes, participate in their communities, and live independently in the setting of their choice.To support understanding and increased uptake of these services over time, this report provides an overview of and evidence summary for six Community Supports most relevant to supporting independent living for older adults and people with disabilities, including:Respite Services. Short-term services aimed at providing relief to caregivers of those who require occasional or temporary assistance or supervision.Nursing Facility Transition / Diversion to Assisted Living Facilities. Services that help people remain in the community by facilitating transitions from a nursing facility back into a home-like, community setting or prevent nursing facility admissions for those with imminent need.Community Transition Services / Nursing Facility Transition to a Home. Nonrecurring support, including setup expenses, to avoid further institutionalization and help people remain in the community as they return home from a licensed nursing facility.Personal Care and Homemaker Services. Supports for people needing assistance with daily activities, such as bathing, dressing, cooking, eating, and personal hygiene.Environmental Accessibility Adaptations (Home Modifications). Physical adaptations to a home when necessary to ensure health, welfare, and safety, or promote greater independence at home through improved functionality and mobility.Medically Supportive Food / Meals / Medically Tailored Meals. Meal services to help people achieve their nutritional goals at critical times (such as after a hospital or nursing facility stay) to regain and maintain their health.

Medi-Cal and Opportunities for Health Tech in Home-Based Medical Care

March 9, 2022

For people living with complex health needs, the usual model of going to the clinic or hospital for care does not always work well. Home-based medical care programs have been designed to fill this gap, providing better care to people living with multiple chronic conditions, functional limitations, and often social risk factors who have difficulty accessing care in traditional settings.This group, which includes seniors as well as younger people living with physical, mental, or developmental disabilities, is large. The state's Medicaid program, Medi-Cal, plays an outsized role in covering their care. Although Medi-Cal covers one in three Californians, it covers more than 50% of those living with a disability. In fact, there are 2.3 million seniors and people with disabilities covered by Medi-Cal, who represent roughly one in three Medi-Cal enrollees.Growing demand from consumers and their caregivers and a favorable policy environment create an opportunity for entrepreneurs and safety-net plans and providers to work together to improve access to these innovative models. This report explores opportunities for innovation, challenges, current policies, and implications for innovators. For this landscape report, the author interviewed a range of stakeholders to understand their perspectives and approaches to home-based medical care in an effort to showcase different models in California's health ecosystem.Readers should note this landscape overview is not intended to be exhaustive, nor is it an endorsement of the companies included. Finally, because solutions landscapes can evolve quickly, this brief may not fully reflect the current market.

In Their Own Words: Black Californians on Racism and Health Care

January 10, 2022

California, home to the most culturally diverse population in the country and the fifth largest Black population of any state, has a major opportunity to be a leader in health equity. But glaring racial and ethnic inequities pervade its health care system, from insufficient access to worse health outcomes to excess mortality. Black residents have the shortest life expectancy (75 years) at birth of any racial/ethnic group, six years shorter than the state average. Black Californians have the highest death rates from breast, cervical, colorectal, lung, and prostate cancers. Black birthing people experience the highest rates of prenatal and postpartum depression, preterm births, low birthweight births, and pregnancy-related mortality. And Black infants have the highest mortality rates.As part of its commitment to ending health inequities, CHCF is funding Listening to Black Californians, a three-phase qualitative and quantitative study to understand the health and health care experiences of Black Californians. This project will also explore the impact of racism on Black Californians' experiences in the health care system, as well as the detrimental effects of racism on their health.EVITARUS, a Black-owned public opinion research firm in Los Angeles, is conducting the research. An advisory group composed of academics, policymakers, providers, and community advocates is guiding the study. Listening to Black Californians will identify policy actions and practice changes at the clinical, administrative, and training levels that policymakers and health system leaders can take to eliminate discrimination in health care and to improve the health outcomes of Black Californians.This report describes the results of Phase I of the Listening to Black Californians study, which was conducted during the summer of 2021. The 100 people interviewed for this phase explained how they think about health and described their individual experiences with California's health care system. While each interview provided unique insights, taken together, the conversations revealed many similarities in how Black Californians view health and how they experience health care. Interviewees shared their perceptions about health, their experiences with racism and health care, and their perspectives on what constitutes quality health care. The study results are summarized on the following page.

Markets or Monopolies? Considerations for Addressing Health Care Consolidation in California

December 1, 2021

Over the past three decades, markets for health insurers and providers have gone through waves of consolidation. As of 2018, 95% of metropolitan areas in the United States had highly concentrated hospital markets. Markets for health insurers are also highly concentrated. Between 2006 and 2014, the combined market share of the top four insurers climbed from 74% to 83%. The coronavirus pandemic appears to be fueling another round of consolidation — especially acquisition of providers by private equity firms.Markets or Monopolies? Considerations for Addressing Health Care Consolidation in California compiles the latest research and data on California's health care systems and shows that consolidation is not limited to any one system, market segment, or geographic region in the state: Most markets across California are highly concentrated. Hospital markets, in particular, are now approaching "monopoly levels" in many California counties. In addition, there is mounting evidence that mergers of health care companies are resulting in increased prices for health care services, with little or no improvement in quality for consumers.The report highlights several actions policymakers could consider, given significant consolidation. For example, California's attorney general has the authority to block transactions that transfer a "material amount of the assets" only for nonprofit health facilities. To increase scrutiny of provider mergers in California, policymakers could require all health care providers — not just nonprofit ones — to provide written notice to, and obtain the written consent of, the attorney general.  Policymakers could also expand the authority of state regulatory agencies to include "affordability standards" when they review health insurance plans for sale in California.

The Medi-Cal Maze: Why Many Eligible Californians Don’t Enroll

September 13, 2021

Millions of Californians have gained health coverage through Medi-Cal, yet many eligible for the program remain uninsured. CHCF commissioned qualitative research to better understand what prevents eligible Californians from enrolling and to identify ways California can make Medi-Cal even more accessible to the population it is designed to serve. Through virtual focus groups and in-depth interviews with 91 Californians, the research team explored the knowledge, attitudes, and enrollment experiences of people who are likely eligible for Medi-Cal yet remain uninsured.

Breaking Down Silos: How to Share Data to Improve the Health of People Experiencing Homelessness

July 13, 2021

Housing is a key social determinant of health. Stable housing can help maintain health and reduce unnecessary emergency room use and hospital admissions, while research indicates that addressing the health-related needs of people experiencing or at risk of homelessness is crucial to accessing and sustaining housing.Because homelessness in California exists on an unprecedented scale — with more than 150,000 people experiencing homelessness on any given day — purposeful collaborations between the health care and homeless systems of care are critical. Such efforts have taken a variety of forms, including Whole Person Care pilot programs and collaborations aimed at improving care for those who frequently touch both the health care and homeless systems of care — while reducing the costs of the two systems so they can serve more people.This report focuses on ways in which California's housing and health care sectors are sharing data to better coordinate and support mutual clients within their communities. Data sharing has been pivotal in breaking down silos and improving coordination between the two systems to better address clients' needs.Yet despite dedicated and committed partnerships in place for cross-sector collaboration, data sharing efforts have not occurred without challenges. Communities have raised a common set of barriers they have faced, including privacy issues, relationships and collaboration, interoperability, and data quality.While there are no uniform ways to address the common challenges, communities have creatively employed strategies and taken advantage of opportunities to continue pushing forward data sharing efforts. These opportunities have proven most effective when tailored to each community's own needs, structures, relationships, and motivations.

Speaking Up: Findings from 2019 Focus Groups and Interviews with Californians with Low Incomes

June 22, 2021

In 2019 CHCF commissioned NORC at the University of Chicago to embark on an extensive research project to better understand the health care needs, wants, and values of California adults (18–64) with low incomes. In April and May of 2019 NORC began by holding multiple focus groups and in-depth interviews with Californians with low incomes who represented various racial/ethnic and language groups as well as regions. All participants were screened for having at least one health care encounter in the previous six months.

Understanding the Rules: Federal Legal Considerations for State-Based Approaches to Expand Coverage in California

February 2, 2018

California policymakers and other stakeholders are exploring state-based approaches to expand or improve coverage within the state. There are myriad ways California might seek to expand coverage as well as address consumer choice and health care affordability. Understanding the Rules: Federal Legal Considerations for State-Based Approaches to Expand Coverage in California identifies four approaches designed to expand coverage that have been discussed among California state policymakers. These include:Establishing a single-payer systemImproving affordability of Covered California plansExpanding Medi-Cal to undocumented adultsCreating a public coverage option on Covered CaliforniaThese approaches interact, to varying degrees, with federal programs and federal laws. This paper explores those interactions to illuminate legal issues that the state and stakeholders would need to consider under each of the approaches.

California’s Ambulatory Surgery Centers: A Black Box of Care

February 1, 2018

Many surgeries are performed in freestanding, or "same-day," ambulatory surgery centers (ASCs). The number of freestanding ASCs in California has increased dramatically over the past 11 years. However, due to a legal decision that removed reporting requirements for ASCs in the state, little is known about the volume of procedures, type of procedures, and financial operation of the vast majority of these facilities. looks at the most recent data on the supply, use, quality, and finances of freestanding ASCs in California, as well as trends from 2005 to 2016.

Medi-Cal Facts and Figures 2017

December 21, 2017

Medi-Cal, California's Medicaid program, pays providers for essential primary, specialty, acute, and long-term care services delivered to more than 13 million Californians: children, their parents, pregnant women, seniors and people with disabilities, and low-income nonelderly adults. The program has undergone a major expansion due to the Affordable Care Act (ACA). Medi-Cal saw a total increase of 5.6 million enrollees between 2013 and 2017. California has also now shifted most enrollees into managed care. The Medi-Cal Facts and Figures set of materials provides an overview of Medi-Cal, covering program eligibility and enrollment, benefits, service delivery, background on policy issues, budget, and forces that affect the program's costs. A 2017 quick reference guide with updated data provides a snapshot of some key Medi-Cal data points. CHCF will publish a fully updated Medi-Cal Facts and Figures report in late 2018.

Key Questions When Considering  a State-Based, Single-Payer System  in California

November 8, 2017

By embracing implementation of the Affordable Care Act (ACA), California has decreased its uninsured rate to an all-time low of 8.5%. Nevertheless, a substantial number of residents remain uninsured, whether ineligible for public coverage due to immigration status or unable to afford coverage; quality of care and access remain uneven, and systemwide health care costs continue to rise. Recent actions by the current federal administration and Congress have called into question the stability of the federal ACA framework. The desire for a simpler, less costly, and more efficient alternative has drawn renewed attention to a potential state-based, single-payer health care system in California. However, "single payer" can mean different things to different people. At its most basic, "single payer" refers to a single centralized, publicly organized means to collect, pool, and distribute money to pay for the delivery of healthcare services for all members of a defined population. The potential of a state-based, single-payer system to deliver improved outcomes depends on policy decisions and design issues that have not yet been fully defined and vetted in California. This paper identifies questions and issues that bring into better focus what single payer could mean for California.

Health Care Costs 101: Spending Rose with More Coverage and Care

September 11, 2017

Health spending in 2015 continued to grow modestly, following a period of historically low growth from 2009 to 2013. National health spending grew by 5.8% in 2015, up from 5.3% in 2014. From 2016 to 2025, health spending is projected to grow at an average rate of 5.6% per year. The spending increases in 2015 were driven by increased use of services as enrollment in Medicaid and private insurance expanded. US health spending reached $3.2 trillion in 2015, or $9,990 per capita, and accounted for 17.8% of gross domestic product (GDP).