For the over six million Californians aged 65 and over, and the over seven and a half million with a disability, getting the care they need has not always been easy

by Selen Ozturk

For the over six million Californians aged 65 and over, and the over seven and a half million with a disability, getting the care they need has not always been easy.

To help these Californians live healthier lives in their own communities, Medi-Cal — California’s version of Medicaid — has new programs including integration with Medicare; elimination of asset limits restricting eligibility; enhanced care management; and expanded community services like housing aid and healthy meals.

At a Wednesday, July 10 Ethnic Media Services briefing, Department of Health Care Services officials and community health care providers explained what new programs are available to older and disabled Californians, how they’re implemented on the ground and how these programs are changing lives.

An overview

Nearly 6 million Californians, or 15 percent of the state’s population, were aged 65 and older as of 2021 according to the U.S. Census — a number projected to grow to over 8.7 million, or 20 percent of the state, by 2030.

The CDC reports that over 7.6 million Californians have a disability.

Dana Durham, DHCS Managed Care Quality and Monitoring Division chief], said Medi-Cal is helping older and disabled Californians through Community Supports and Enhanced Care Management (ECM), programs that “meet social drivers of health” — like housing, healthy food, language access, and preventative health care — “in people’s communities so they can stay in the least restrictive setting possible.”

Community Supports include medically tailored meals, transportation to and from appointments, in-home care, home accessibility modifications, long-term care transition assistance, mental health care, substance abuse disorder treatment and housing aid.

“Historically, the healthcare system has been difficult to navigate,” particularly isolating seniors and people with disabilities, Durham continued.

With ECM, introduced in January 2022, high-risk members or those with complex needs — for example, overlapping issues of dementia, mental health, and daily living — are assigned a lead care manager to help them navigate the system and access Medi-Cal services. These care leads can travel to meet the member if need be; for instance, the patient is homeless, disabled or isolated.

For Californians eligible for both Medi-Cal and Medicare, the federal insurance program for seniors and some younger people with disabilities, there are also now dual Medi-Medi Plans in 12 counties that cover copays and services across b​oth programs, said Anastasia Dodson, DHCS deputy director of the Office of Medicare Innovation and Integration.

In 2026, Medi-Medi will be available statewide.

Currently, of the 6.6 million Californians on Medicare, 1.6 million are also on Medi-Cal.

Dodson added that in January 2024, Medi-Cal eliminated asset limits, meaning that bank accounts, property or a second car won’t affect eligibility; now, only income and household size count.

Community perspectives

Since this expansion of Medi-Cal began in 2022, “We went from three counties to nine statewide where we provide ECM and connection to community supports like doctors, caregivers, meals, transportation, residential care away from nursing homes, home accessibility modifications, housing navigation and rent aid,” said Jenna LaPlante, senior director of care management programs at the Institute on Aging, which serves about 1,000 Medi-Cal members.

“It’s more than we’ve ever served, and we’re in talks with health plans to expand more,” she continued. “Hiring bilingual, bicultural staff from the communities we serve has been key to reaching communities who weren’t historically engaging with our services.”

“For example, we hired a Vietnamese-speaking care manager who went to community centers in San Jose and Santa Clara counties where there’s a large population. We got a huge influx, and could hire more VIetnamese-speaking staff, which increased referrals even more,” LaPlante explained. “We’re now doing the same thing in Merced County, posting jobs for Spanish-speaking staff.”

“This recent expansion to use Medicaid dollars for social determinants of health, like first month’s rent and a security deposit, is incredibly novel. I don’t see it anywhere else,” she added. “Each state can apply to waive how they use federal dollars for more than just medical services. Some do and some don’t … but here in California, we’re at the forefront.”

With older and disabled Californians, health risks often overlap across many areas of life, not just physical health concerns — for instance, if “they’re homeless with no income, no food, and they need a wheelchair,” said Carrie Madden, program director of Aging and Disability Resource Connection of Central and South LA (ADRC), a social service counseling and referral organization.

“What’s really been helpful is being able to coordinate and refer them to services that address these different areas,” she continued. “We have no wrong door. People who call us will get some kind of referral … and we follow up to make sure they get the services they need to live out of nursing homes and treatment facilities, back in the community they came from … With the Medi-Cal change now, we’re seeing individuals get this help much faster.”

ADRC is partnered with Communities Actively Living Independent and Free (CALIF), one of 28 independent living centers in California.

Keith Miller, executive director of CALIF, said “Recently we entered a contract with an insurance provider to provide these new Medi-Cal programs like housing navigation or retention, assistive technology and ongoing case management,” particularly for people frequently entering emergency rooms.”

At CALIF, where “51 percent of our staff are people with disabilities,” this transformation of Medi-Cal crucially helped “keep our clients out of institutions and nursing homes,” he added.

Lilly Sanchez, case manager at CALIF, shared the story of how this transformation changed the life of one high-risk client who was often in the ER and about to enter a nursing home before he was referred to CALIF, which helped him enroll in Medi-Cal and stay in his community over the course of three months.

“When he came to us, he didn’t have in-home support, no California ID, couldn’t transport himself to and from the services he needed,” she explained. “We were able to do the paperwork for him and coordinate our social services with medical care through the insurance plan.”

“Because of that coordination of care, he is currently housed, he has in-home support, he has food nurtures him to stop needing the emergency room as much as he was before,” Sanchez continued.

“This speaks to how important it is not only to have medical care available but to coordinate it with all the other social services people need to be healthy,” she added. “Medi-Cal is making that coordination possible.”

by CF

California Gov. Gavin Newsom issued an executive order Thursday to direct state agencies on how to remove homeless encampments, a month after a Supreme Court ruling allowing cities to enforce bans on sleeping outside in public spaces.

Newsom’s order is aimed at the thousands of tents and makeshift shelters across the state that line freeways, clutter shopping center parking lots and fill city parks. The order makes clear that the decision to remove the encampments remains in local hands.

The order comes after a decision by the U.S. Supreme Court earlier this summer allowing cities to enforce bans on sleeping outside in public spaces.

The case was the most significant on the issue to come before the high court in decades and comes as cities across the country have wrestled with the politically complicated issue of how to deal with a rising number of people without a permanent place to live and public frustration over related health and safety issues.

“There are simply no more excuses. It’s time for everyone to do their part,” Newsom said in a statement.

While Newsom cannot order local authorities to act, his administration can apply pressure by withholding money for counties and cities.

California is home to roughly one-third of the nation’s population of homeless people, a problem that has dogged Newsom since he took office. Newsom touted that his administration has spent roughly $24 billion aimed at cleaning up streets and housing people but acknowledged the stubbornness of the issue.

Newsom’s administration has also come under fire recently after a state audit found that the state didn’t consistently track whether the huge outlay of public money actually improved the situation.

Newsom has worked hard to address the issue. He threw all of his political weight behind a ballot measure earlier this year to allow the state to borrow nearly $6.4 billion to build 4,350 housing units, which passed with a razor-thin margin.

The order comes as Republicans have stepped up their criticisms of California and its homelessness crisis as Vice President Kamala Harris — a former California district attorney, attorney general and senator — launches her presidential campaign. Harris entered the race over the weekend after President Joe Biden’s announced that he would not seek reelection. Newsom himself has presidential ambitions.

Under Newsom’s direction, state agencies — including state parks and department of transportation — would be required to prioritize clearing encampments that pose safety risks, such as those camping along waterways. Officials should give advance notice to vacate, connect homeless people to local services and help store their belongings for at least 60 days. Local cities and counties are urged to adopt similar protocols.