메디칼 커뮤니티 지원은 약속을 이행하고 있습니다: 회원의 요구 충족 및 비용 절감​​ 

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:​​ 

• 2024년에는 252,000명 이상의 메디칼 가입자에게 494,000건 이상의 커뮤니티 지원금이 전달되었습니다.​​ 
• 현재 23개 카운티의 12개 Medi-Cal MCP는 승인된 14개 커뮤니티 지원을 모두 제공하며, 주 전역의 모든 MCP는 최소 8개 이상의 서비스를 제공합니다.​​ 
• 연구 대상인 12개 서비스 모두 비용이 많이 드는 입원 서비스 및/또는 응급실 이용률 감소와 관련이 있었습니다.​​ 
  
  • 주택 트리오 커뮤니티 지원(주택 전환 탐색 서비스, 주택 보증금, 주택 임차 및 유지 서비스) 중 하나 이상을 이용한 회원은 그 후 6개월 동안 입원 및 응급실 이용이 각각 24.3건(% ), 13.2건(%) 감소했습니다.​​ 
  • 연구 대상 회원 수가 가장 많은 의료 맞춤형 식사/의료 지원 식품은 입원 및 응급실 이용률의 상당한 감소와 관련이 있었습니다(각각 21.4% 및 22.0%).​​ 

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:​​ 

• 주택 보증금은 31.6% 순 비용 절감.​​ 
• Day Habilitation은 17.1% 순 비용 절감과 관련이 있습니다.​​ 
• 금주 센터는 11.7% 순 비용 절감과 관련이 있습니다.​​ 
• 임시 간호 서비스는 61.3% 순 비용 절감.​​ 
• 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.​​ 

DHCS는 주 전역의 메디칼 가입자의 건강 관련 사회적 요구를 더 잘 충족하기 위해 커뮤니티 지원을 확대하고 강화하기 위해 계속 노력하고 있습니다. 캘리포니아는 예방, 존엄성, 안정을 통해 전인적 치료를 해결하려는 그간의 노력을 바탕으로 수익성을 주시하면서 전인적 치료를 위한 노력을 계속하고 있습니다. 이 접근 방식은 특히 피할 수 있는 의료 서비스 이용을 줄이고 다양하고 복잡한 건강 요구가 있는 회원의 경험을 개선하는 데 있어 이미 변화를 일으키고 있습니다.​​ 

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