SUCCESS OF MEDI-CAL TRANSFORMATION CONTINUES AS LATEST ENHANCED CARE MANAGEMENT AND COMMUNITY SUPPORTS DATA REPORT SHOWS PROGRESS
SACRAMENTO - The Department of Health Care Services (DHCS) today released the
latest quarterly update on
Enhanced Care Management and
Community Supports data, showing a significant increase in the use of these benefits and services by Medi-Cal members. Enhanced Care Management is a statewide Medi-Cal benefit available to members with complex needs who can receive comprehensive care management for all of their health and health-related care, including physical, mental, and dental care and social services. Community Supports are services provided by Medi-Cal managed care plans (MCPs) to address Medi-Cal members' health-related social needs.
“We're seeing a significant increase in Medi-Cal members using Enhanced Care Management and Community Supports, which reflects our commitment to both meeting the needs of members who require more intensive health care services and closing health equity gaps," said
DHCS Director Michelle Baass. “We're pleased to see more members accessing these vital benefits and services."
Enhanced Care Management 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, services for individuals who need assistance with activities of daily living and instrumental activities of daily living who could otherwise not remain at home, and personal services to create a person-centered approach to care (includes house cleaning, meal preparation, laundry, grocery shopping, personal care services, accompaniment to medical appointments, and protective supervision). These holistic services help members live healthier lives and avoid higher, costlier levels of care.
WHAT THE DATA SHOW: The data report shows an increase in the availability and use of Community Supports, with more counties offering services and reaching more Medi-Cal members under age 21. Overall, between Quarter (Q)3 and Q4 2023, Community Supports recipients rose 26 percent to 86,000 members. In the program's first two years, about 140,000 unique Medi-Cal members used Community Supports, totaling more than 350,000 services delivered.
Additionally, the number of members served by Enhanced Care Management quarter over quarter continues to rise; in Q4 2023, approximately 96,000 members received Enhanced Care Management, a 40 percent increase from Q4 2022. The number of members under age 21 nearly doubled in Q4 2023 from the previous quarter, from 6,400 to 12,000 members, many of whom were newly eligible for Enhanced Care Management in July 2023. Altogether, more than 183,000 Medi-Cal members across the state received Enhanced Care Management in the first two years of the benefit.
As of January 2024, 19 counties across California offered all 14 Community Supports. At least eight Community Supports are offered in all counties, a significant expansion from the year before.
"Every individual deserves health care services that respect their unique needs, ensure fair access to resources, and prioritize their health and well-being," said
State Medicaid Director Tyler Sadwith. “Every child deserves the opportunity to thrive without financial barriers hindering their access to medical services and support."
WHY THIS MATTERS: The latest Enhanced Care Management and Community Supports Quarterly Implementation Report update shows continued growth in utilization as eligibility is expanded to reach new
Populations of Focus (POFs) and as additional Community Supports services are offered in more counties across the state. DHCS expects to see a further increase in enrollment in Enhanced Care Management and Community Supports in the next quarterly report, which will reflect the expansion of Medi-Cal eligibility to adults ages 26-49 that occurred in January 2024. As California continues transforming Medi-Cal, Enhanced Care Management 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 is committed to supporting and sustaining this growth by watching programs closely, making informed improvements, increasing standardization, and providing direct technical assistance.
WHAT THEY ARE SAYING: “Seeing the improvement in health care equity for kids from low-income families is truly heartening," said
Contra Costa County Public Health Officer Dr. Ori Tzveili. “It shows we're working to make sure every child gets the care they need, no matter their financial situation."
“We have expanded our Community Supports services this year and are committed to ensuring even more Medi-Cal members have access to the quality, equitable care and resources they need for a healthier future," said
Monica Dedhia, Director of Community Health at the Children's Institute. “We steadfastly believe that housing is health care, and we are pleased to provide both Community Supports services and Enhanced Care Management benefits to stabilize housing needs, in addition to addressing all social drivers of health."
ABOUT THE BENEFIT AND SERVICES: The
Enhanced Care Management benefit provides high-touch, person-centered care management to Medi-Cal members with the most complex medical and social needs. Members receiving Enhanced Care Management have a single lead care manager who helps 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 MCPs to help members address their health-related social needs, such as access to safe housing or healthy meals to help them recover from illness, avoid more serious health care conditions, and stay well.
TAKING ACTION: DHCS and its MCP partners are working to expand access and use of Enhanced Care Management and Community Supports in 2024 and beyond. This work includes:
- Expanding access to the Enhanced Care Management benefit, with additional POFs qualifying for Enhanced Care Management 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
Enhanced Care Management 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 Enhanced Care Management and Community Supports through
Providing Access and Transforming Health, a $1.85 billion initiative.
- Hosting regular
listening sessions, including PATH Collaborative Planning and Implementation workgroups for providers and community members across the state, welcoming feedback on the implementation of Enhanced Care Management and Community Supports from diverse stakeholder groups.
- Encouraging MCPs to further increase use of Enhanced Care Management and Community Supports through the
Incentive Payment Program.
- Expanding the variety of methods that assist MCPs in identifying members who may benefit from Enhanced Care Management and Community Supports. This includes proactively ensuring contracted networks of providers are aware of the Enhanced Care Management benefit and Community Supports services, what the eligibility criteria are, and encouraging and making clear the pathway for submitting referrals to MCPs.
- Ensuring MCP public-facing websites, member handbooks, and provider directories include the most up-to-date information about the Enhanced Care Management and Community Supports offered and how to access them.
BIGGER PICTURE: DHCS is transforming Medi-Cal to ensure Californians can get comprehensive care to improve their health and well-being. Medi-Cal members have access to enhanced services that address physical and mental health needs, extending beyond traditional medical settings. These improvements establish a more coordinated, person-centered, and equitable health system that serves everyone equally, regardless of race, ethnicity, gender, sexual orientation, disability, immigration status, location, or health needs. With this transformation, Medi-Cal is providing Californians with the care they need to build a healthier and more equitable state.