يفي برنامج الدعم المجتمعي medi-cal بوعده: تلبية احتياجات الأعضاء وخفض التكاليف​​ 

SACRAMENTO — The California Department of Health Care Services (DHCS) today announced the availability of data showing that Medi-Cal Community Supports are successful and cost-effective. The data show that Community Supports are delivering on their promise to address Medi-Cal member needs—reducing avoidable emergency department visits, hospital stays, and long-term care use while showing strong early signs of cost savings. All 12 Community Supports studied are reducing costs, and of these, nine have already demonstrated cost-effectiveness within the initial study period. The remaining three are projected to reach that threshold over a longer study period, consistent with federal rules for evaluating cost-effectiveness.​​ 

“Community Supports represent a fundamental shift in how we deliver health care to Californians, enhancing quality of care for Medi-Cal members and strengthening the overall efficiency and equity of our health care system,” said DHCS Director Michelle Baass. “These findings confirm that these services are not only improving lives, but also reducing avoidable health care costs. By scaling these supports statewide, we’re making meaningful progress toward a person-centered Medi-Cal system that meets members where they are and prioritizes prevention, dignity, and value.”​​ 

California’s Community Supports were approved in the California Advancing and Innovating Medi-Cal (CalAIM) waivers and phased in by Medi-Cal managed care plans (MCP) beginning in 2022. CalAIM is the state’s initiative to transform Medi-Cal to improve care quality, reduce complexity, and advance equity through data-driven, whole-person care initiatives.​​ 

WHY THIS MATTERS: Medi-Cal currently offers 14 Community Supports. These services promote housing stability, ease transitions from institutional settings, support in-home care, provide healthy meals, and offer caregiver relief, helping members avoid costlier hospital or emergency care. The report analyzed 12 of these supports to assess their impact on health and cost outcomes. These 12 out of 14 Community Supports were studied because they are authorized under California’s 1915(b) CalAIM waiver, which California is required to report on each year to the federal government.​​ 

DHCS submitted its annual 2024 report to the federal Centers for Medicaid & Medicare Services. It analyzes the impact of 12 Community Supports on member health care, including a new cost-effectiveness analysis for calendar year 2023. Key highlights from the report include:​​ 

• في عام 2024، تم تقديم أكثر من 494,000 دعم مجتمعي لأكثر من 252,000 عضو من أعضاء Medi-Cal.​​ 
• تقدم الآن اثنا عشر برنامجًا من برامج Medi-Cal المجتمعية الشاملة في 23 مقاطعة جميع برامج الدعم المجتمعي ال 14 المعتمدة؛ وتقدم جميع برامج الدعم المجتمعي الشاملة على مستوى الولاية ثمانية برامج على الأقل.​​ 
• ارتبطت جميع الخدمات الـ 12 التي خضعت للدراسة بتخفيضات في خدمات المرضى الداخليين و/أو قسم الطوارئ.​​ 
  
  • الأعضاء الذين استخدموا واحدًا على الأقل من الدعم المجتمعي الثلاثي للإسكان (خدمات الملاحة الانتقالية للإسكان، وودائع الإسكان، وخدمات إيجار المساكن وخدمات الاستدامة) قد قللوا من استخدام المرضى الداخليين وقسم الطوارئ بنسبة 24.3% و13.2% على التوالي في الأشهر الستة التالية.​​ 
  • ارتبطت الوجبات المصممة طبياً/الأغذية الداعمة طبياً، والتي تضم أكبر عدد من الأعضاء الذين خضعوا للدراسة، بانخفاض كبير في استخدام المرضى الداخليين وقسم الطوارئ (21.4% و22.0% على التوالي).​​ 

COST-EFFECTIVE ANALYSIS: Research showed that 9 of the 12 Community Supports studied are already demonstrably cost-effective, and three are likely to be proven so over time, consistent with federal rules. Members using these services typically saw net reductions in (or offsets of) applicable service costs. Examples include:​​ 

• ارتبطت ودائع الإسكان بـ 31.6% صافي تخفيض التكلفة.​​ 
• ارتبط التأهيل النهاري بتخفيض صافي التكلفة بمقدار 17.1%.​​ 
• ارتبطت مراكز الرصانة بانخفاض صافي التكلفة 11.7%.​​ 
• ارتبطت خدمات الرعاية المؤقتة بنسبة 61.3% صافي تخفيض التكلفة.​​ 
• Personal Care and Homemaker Services were associated with a 58.4% net cost reduction.​​ 

The cost-effectiveness analysis may be understated due to the short evaluation period, resulting in immediate costs being fully captured but not longer-term savings. DHCS acknowledges that broader initiatives, like Enhanced Care Management, may influence these results. Future evaluations may refine these methods as more data become available, and an independent evaluation will be conducted in line with waiver requirements.​​ 

IMPACT OF COMMUNITY SUPPORTS: The expansion of Community Supports has increased access in rural and underserved areas, with health plans such as Anthem Blue Cross, Health Net, and Partnership HealthPlan of California leading efforts to introduce new services in both urban and rural counties. These three plans are among the largest in the state and demonstrated significant expansion of Community Supports in 2024, both in terms of the number of new services elected and geographic spread, particularly in rural counties. As a result, Medi-Cal members in all 58 California counties now have access to a broad array of Community Supports.​​  

WHAT’S NEXT: DHCS released an updated Community Supports Policy Guide that is aligned with the Enhanced Care Management and Community Supports Action Plan. On July 1, 2025, the new Transitional Rent benefit will be optional for MCPs to offer, and will become the first mandatory Community Support on January 1, 2026.​​ 

لا تزال إدارة خدمات الرعاية الصحية الشاملة ملتزمة بتوسيع نطاق الدعم المجتمعي وتعزيزه لتلبية الاحتياجات الاجتماعية المتعلقة بالصحة لأعضاء ميدي-كال على مستوى الولاية. تستفيد كاليفورنيا من جهودها التاريخية في معالجة الرعاية الصحية الشاملة من خلال الوقاية والكرامة والاستقرار، مع مراعاة الحد الأدنى من الرعاية. يُحدث هذا النهج فرقًا بالفعل، لا سيما في الحد من استخدام الرعاية الصحية التي يمكن تجنبها وتحسين تجربة الأعضاء ذوي الاحتياجات الصحية المتعددة والمعقدة.​​ 

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