California'​s Medi-Cal Transformation Continues

 
SACRAMENTO — The Department of Health Care Services (DHCS) today released a quarterly update on the latest Enhanced Care Management (ECM) and Community Supports data. The data show an uptick in both the availability and use of Community Supports, showing significant growth in the number of counties offering these services.

ECM and Community Supports improve Medi-Cal members' overall health and well-being by addressing both medical and social factors that can impact a person's health, including housing assistance, medically tailored meals to support short-term recovery, homemakers, and personal services to create a high-touch, person-centered approach to care.

“Every day, more Medi-Cal members are benefitting from personalized care that goes beyond the traditional doctor's office or hospital setting," said DHCS Director Michelle Baass. “Enhanced Care Management and Community Supports are two key pillars of Medi-Cal transformation, and we're seeing a great response. But there is still room to help even more people."
 
“California Advancing and Innovating Medi-Cal (CalAIM) is a nation-leading effort that requires the support of all individuals, organizations, and health plans trusted with delivering care to members," said State Medicaid Director Tyler Sadwith. “We are working closely with stakeholders, providers, and Medi-Cal managed care plans to ensure members and their caregivers know they can readily access these transformative services."

WHAT THE DATA SHOW: As of January 2024, 23 counties offered all 14 Community Supports, and all counties offered at least seven Community Supports. This marks a significant increase from the end of 2022, when only three counties offered all 14 Community Supports. Overall, approximately 103,000 Californians (via Medi-Cal) used Community Supports in the first 21 months of the program, with more than 186,000 total services delivered. There is significant quarter-over-quarter growth in utilization; approximately 62,000 Californians (via Medi-Cal) utilized Community Supports in quarter (Q)3 2023 alone, up 170 percent from Q4 2022.

Additionally, the number of Californians on Medi-Cal served by ECM each quarter is up; in Q3 2023, approximately 86,000 members received ECM, up 28 percent from Q4 2022. The Q3 2023 total includes 6,300 members under age 21, many of whom were newly eligible for ECM in July 2023. Altogether, more than 160,000 Medi-Cal members across the state received ECM in the first 21 months of the benefit.

WHY THIS MATTERS: This latest update shows a sustained increase in utilization as additional Populations of Focus (POF) become eligible for ECM and additional Community Supports services are offered in counties across the state.

DHCS expects to see more enrollment growth across ECM and Community Supports in the coming months and years. As California continues transforming Medi-Cal, ECM and Community Supports play a critical role in supporting whole-person care for Medi-Cal members with complex medical and health-related social needs. DHCS remains committed to supporting and sustaining this growth through program monitoring, design improvements, standardization, and direct technical assistance.

WHAT THEY'RE SAYING:

• “At Pacific Clinics, everything we do helps the people we serve to achieve their wellness goals and advance health equity. Medi-Cal transformation is essential to this work," said Vice President of Emerging and Statewide Services Jacquelyn H. Torres. “Through Community Supports, we provide crucial pathways to affordable housing for individuals and families. Additionally, Enhanced Care Management ensures access to comprehensive services tailored to meet complex health needs with life-affirming services and care."
  

• “Enhanced Care Management represents a critical new safety net service in California," said Leticia Galyean, CEO of Seneca Family of Agencies. Seneca is a nonprofit provider of behavioral health services to young people and their families, and currently holds 10 ECM contracts with managed care plans across the state. “Seneca is integrating Enhanced Care Management services with our full continuum of prevention and intensive services for young people, promoting true whole-person care and cross-system integration and collaboration in ways we could not before."
  

ABOUT THESE BENEFITS AND SERVICES: The ECM benefit provides high-touch, person-centered care management to Medi-Cal members with the most complex medical and social needs. Members receiving ECM have a single lead care manager who helps them coordinate health-related care and social services, making it easier for them to get the right care at the right time in the right setting—often where they are located. Community Supports are 14 services provided by Medi-Cal managed care plans to help members address their health-related social needs, such as access to safe housing or healthy meals to aid in their recovery from illness, avoid higher and costlier levels of care, and live healthier lives.

TAKING ACTION: DHCS and its managed care plan partners are working to expand access and use of ECM and Community Supports in 2024 and beyond by:

• Expanding access to the ECM benefit, with additional POFs qualifying for ECM starting January 1, 2024, and increasing the number of available Community Supports services in each county across the state.
• Refining program operations and policies to eliminate barriers to provider contracting and service use through an ECM and Community Supports Action Plan that includes streamlining authorizations and referral processes, expanding provider networks, and improving data exchange.
• Providing grant funding and technical assistance to support providers in implementing and expanding capacity for ECM and Community Supports through Providing Access and Transforming Health​ (PATH), a $1.85 billion initiative.
• Hosting regular listening sessions, including PATH Collaborative Planning and Implementation (CPI) Initiative workgroups for providers a​nd community members across the state, welcoming feedback on the implementation of ECM and Community Supports from diverse stakeholder groups for providers and community members across the state.
• Encouraging managed care plans to further increase utilization of ECM and Community Supports through the Incentive Payment Program.
• Expanding and utilizing a variety of methods as required in managed care plan contracts to identify members who may benefit from ECM and Community Supports. This also includes proactively ensuring contracted networks of providers are aware of the ECM benefit and Community Supports services and what the eligibility criteria are, and making clear the pathway for submitting referrals to managed care plans.
• Ensuring managed care plan public-facing websites, member handbooks, and provider directories include the most up-to-date information about ECM and Community Supports offered and how to access them.
  

BIGGER PICTURE: DHCS is transforming Medi-Cal to ensure Californians can get the care they need to live healthier lives. Medi-Cal members have access to new and improved services and receive comprehensive care that goes beyond the doctor's office or hospital and addresses all of their physical and mental health needs. These changes will create a more coordinated, person-centered, and equitable health system that works for everyone, regardless of race, ethnicity, gender, sexual orientation, disability, immigration status, location, or health needs.

Medi-Cal is leading the nation in providing Californians with access to the care they need to build a healthier and more equitable state.​​