LOS APOYOS COMUNITARIOS DE MEDI-CAL ESTÁN CUMPLIENDO SU PROMESA: SATISFACER LAS NECESIDADES DE LOS MIEMBROS Y REDUCIR LOS COSTOS​​ 

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:​​ 

• En 2024, se entregaron más de 494,000 apoyos comunitarios a más de 252,000 miembros de Medi-Cal.​​ 
• Doce MCP de Medi-Cal en 23 condados ahora ofrecen los 14 Apoyos Comunitarios aprobados; todos los MCP en todo el estado ofrecen al menos ocho.​​ 
• Los 12 servicios estudiados se asociaron con reducciones en los servicios de hospitalización más costosos y/o en el departamento de emergencias.​​ 
  
  • Los miembros que utilizaron al menos uno de los Apoyos Comunitarios del Trío de Vivienda (Servicios de Navegación para la Transición de la Vivienda, Depósitos de Vivienda y Servicios de Arrendamiento y Sostenimiento de la Vivienda) redujeron el uso de pacientes hospitalizados y del departamento de emergencias en un 24.3% y un 13.2%, respectivamente, en los seis meses siguientes.​​ 
  • Las comidas médicamente adaptadas/alimentos de apoyo médico, que tienen el mayor número de miembros estudiados, se asociaron con reducciones sustanciales en el uso de pacientes hospitalizados y del departamento de emergencias (21,4 % y 22,0 %, respectivamente).​​ 

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:​​ 

• Los depósitos de vivienda se asociaron con un 31,6% Reducción neta de costos.​​ 
• La habilitación diurna se asoció con una reducción de costos netos del 17.1%.​​ 
• Los Centros de Sobriedad se asociaron con una reducción de costos netos del 11.7%.​​ 
• Los servicios de relevo se asociaron con un 61,3% Reducción neta de costos.​​ 
• 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.​​ 

DHCS mantiene su compromiso de expandir y fortalecer los Apoyos Comunitarios para satisfacer mejor las necesidades sociales relacionadas con la salud de los miembros de Medi-Cal en todo el estado. California se basa en sus esfuerzos históricos para abordar la atención integral de la persona a través de la prevención, la dignidad y la estabilidad, sin perder de vista el resultado final. Este enfoque ya está marcando la diferencia, particularmente en la reducción del uso evitable de la atención médica y en la mejora de la experiencia de los miembros con necesidades de salud múltiples y complejas.​​ 

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