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.

In three rulings the U.S. Supreme Court dealt a body blow to the federal bureaucracy. From healthcare to climate to workers’ rights, California’s rules often go farther

by Ben Christopher

But as the state discovered then, there is a limit to how far California can go its own way. Many federal statutes explicitly prohibit states from overriding them. Such federal preemption has been decreed by the courts in other cases.

“Sometimes yes, California can go on its own,” said Ashutosh Bhagwat, an administrative law professor at UC Davis. “Sometimes it absolutely can’t, and sometimes it’s complicated.”

Three rulings against the bureaucracy

In what may be the most consequential of the session’s three regulatory rulings, the court’s conservative majority swept aside a 40-year-old judicial rule of thumb, known as “Chevron deference.”

The concept, named for the 1984 case that spawned it, required judges to defer to a federal regulator’s interpretation of how to implement a Congressional statute. In a high school civics class version of government, Congress passes the laws and the executive branch, with the President sitting at the top, simply enforces them. But enforcement is rarely simple. Congressional laws can be vague or fail to anticipate every eventuality, technological development or unforeseen problem. Since the New Deal, the federal government’s powers and responsibilities have expanded and grown more complex.

Chevron deference is the notion that if a statute is ambiguous and an agency’s interpretation is reasonable on its face, courts should let the bureaucracy call the shots.

No more.

In his opinion, Supreme Court Chief Justice John Roberts wrote that courts may “respect” federal agency expertise, but cannot automatically defer to it. “Agencies have no special competence in resolving statutory ambiguities. Courts do,” he wrote. The upshot: Regulated industries now have a better shot at successfully challenging the federal rules that govern them.

Building on the theme of putting a leash on federal bureaucrats, the majority also ruled against the Securities and Exchange Commission and put new limits on when agencies can use in-house administrative courts to levy fines, instead requiring agencies to take alleged rulebreakers to court.

In a third opinion, the Supreme Court ruled that the six-year statute of limitations for when an aggrieved business can challenge a federal regulation starts ticking whenever that suing party is first affected by the rule. Financial regulators in that case had argued that the shot clock starts when the rule itself is enacted, giving regulations a degree of finality once that time expires.

All three rulings were decided 6-3, with the court’s conservatives in the majority.

Climate change regulations especially vulnerable

In her dissent in the statute of limitations case, Justice Ketanji Brown Jackson, a Biden appointee, warned that together with the end of Chevron deference, the court’s rulings would unleash a “tsunami of lawsuits against agencies” with the “potential to devastate the functioning of the Federal Government.”

Legal experts are still debating just how consequential these rulings will be. Granting less flexibility to federal regulators and opening them up to the threat of indefinite legal challenge from regulated industries implicates an unknowably vast universe of rules. But no one knows which rules are most vulnerable until they wind up in court.

“We’ll probably see now a wave of litigation challenging regulations that many had thought of as being long-settled, and how that shakes out in terms of its application to California businesses and California residents and consumers, we just don’t know,” said Julia Stein, an environmental law professor at UCLA.

Climate change regulations may be especially ripe for challenge. Lacking much actual legislation on the subject from Congress, the Environmental Protection Agency has resorted to creative interpretations of old environmental statutes, like the 1970 Clean Air Act, to justify its rules governing greenhouse gas emissions.

Such creativity may no longer fly, at least with conservative judges.

Federal regulators are “kind of hamstrung in the ability to take innovative approaches,” Stein said, now that the Chevron decision is history. “States, like California, are going to try to make up for that on the back end through their own authority and regulatory power, but it won’t be nearly as effective as if both those entities were working together.”

When a state can set its own rules isn’t always clear. Almost 60 years ago, Congress granted California the authority to set its own emission standards for vehicles. But a California mandate requiring major truck manufacturers to ramp up the sale of zero-emission vehicles might be an early test case, since experts are divided as to whether an interpretation of the Clean Air Act properly allows for such a law.

California, above and beyond

There are areas of the regulatory universe where California law clearly can, and often does, go far above what the feds require.

Labor law is one example.

Most California workplace laws are more protective of employees than federal rules. Not only is the state’s $16 minimum wage more than double that required nationwide, the state also maintains and enforces its own rules on overtime pay, independent contractor status, workplace discrimination and workplace safety.

Most recently, the federal Occupational Safety and Health Administration proposed a rule requiring employers to protect workers from heat illness. California’s own workplace safety agency has had such a rule in place since 2005 for outdoor workers and is expanding it to those working indoors this year.

Those rules will stand regardless of legal challenges at the federal level.

Such challenges are already on the way elsewhere. The same day the high court snagged final say over rulemaking from federal agencies, a Texas judge cited the Chevron-ending decision in putting a new Biden administration overtime rule on hold for state employees.

A long established stereotype of California would suggest that lawmakers here are already ideologically predisposed to out-red tape Washington. But many of California’s supercharged state rules are of recent vintage, born out of resistance to the Trump administration.

In 2019, then-California state Sen. Hannah-Beth Jackson authored a handful of laws to put the federal rules that govern gender discrimination in schools and universities into state statute. That was in anticipation of controversial changes to Title IX, a 1972 civil rights law, proposed by the Trump administration.

Federal education regulators have mined Title IX’s mere 37 words to justify regulations on everything from school sports to sexual assault reporting standards to scholarships.

Protections for wetlands and migratory birds and bans of certain pesticides were also ratcheted up in California during the Trump era.

But that blue state playbook didn’t always go as planned.

In 2019, San Diego Sen. Toni Atkins, then the top Democrat in the state Senate, authored a bill to anti-Trump “backstop, essentially copy-and-pasting the more stringent federal ​​environmental and workplace rules from the Obama era onto the state’s books. Gov. Gavin Newsom vetoed that bill, calling it “a solution in search of a problem.”

California: A vision of life after Chevron?

The raft of rulings were momentous, but not especially surprising to many court watchers. The Supreme Court had been either ignoring or actively chipping away at Chevron deference for years.

That has some legal experts, even self-described liberals, skeptical that the final effect will be as dramatic as the Supreme Court’s liberal dissenters and many alarmed commentators have suggested.

“The major clean water and clean air acts were passed in the ‘70s, long before Chevron,” said Bhagwat at UC Davis. “There was administrative law before that. So, the idea that you can’t have administrative law without Chevron is stupid.”

Ironically, anyone looking to see what a post-Chevron world might look like could turn to California. State courts never adopted a Chevron-like rule in reviewing regulations. Instead, they’ve taken a more holistic approach, in which agency interpretations might be granted more weight when they’ve been consistent over time and are based on its own area of expertise. That, in effect, is pretty similar to the new rules of the federal road laid out last month by the U.S. Supreme Court.

“So when people say, ‘Oh, this is kind of the end of the world, abolishing Chevron,’ it’s like, well, it hasn’t been the end of the world in California,” said Keith Bishop, a partner with the law firm Allen Matkins who used to work as a California state financial regulator. “At least, not yet.”

Still, there are reasons to believe that certain courts outside of California will be keener to uproot regulations than they have been in California. That isn’t a result of differences in legal doctrine between courts, but of political philosophy, said David Carpenter, an appellate lawyer and partner at the law firm Sidley.

“In California, there would be a view that courts are going to be relatively more inclined to abide by or to follow or consider or give weight or respect to agency interpretations,” he said. “Depending on what jurisdiction the challenge is raised in, you might expect more hostility between the federal court and whichever administration is in power.”

Bhagwat shares the view that the outcome of a regulatory challenge will depend largely on the ideology of a given judge or court. That has led him to offer a less dramatic forecast of the law after this year’s spate of anti-regulatory rulings. “They were ignoring Chevron anyway,” he said. But it has led him to a much more dramatic and darker view of the law in general.

“We’re seeing the judiciary starting to reflect the polarization generally in American society,” he said. “There’s this sort of brutal reality on the ground, which is that the law doesn’t matter that much anymore.”

Rachel Becker and Jeanne Kuang contributed reporting to this story.