新闻稿​​ 

加州医疗保险继续转型​​ 

新数据显示，更多县正在实施增强型护理管理和社区支持，帮助更多加州人获得所需的护理​​ 

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.​​ 

此外，每季度接受 ECM 服务的加州医保人数也在增加；2023 年第三季度，约有 86,000 名成员接受了 ECM 服务，比 2022 年第四季度增加了 28%。2023 年第三季度的总数包括 6,300 名 21 岁以下的会员，其中许多人在 2023 年 7 月新符合 ECM 资格。在该福利实施的前 21 个月，全州共有超过 16 万 Medi-Cal 会员接受了 ECM。​​ 

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.​​ 

他们在说什么​​ 

• “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.”​​ 

了解这些福利和服务：ECM 福利为具有最复杂的医疗和社会需求的 Medi-Cal 会员提供高接触性、以人为本的护理管理。接受 ECM 的会员有一名首席护理经理，帮助他们协调与健康相关的护理和社会服务，使他们更容易在正确的时间、正确的地点（通常是他们所在的地方）获得正确的护理。社區支援是加州醫療保險管理性護理計劃提供的 14 種服務，幫助會員解決與健康相關的社會需求，例如獲得安全的住房或健康的膳食，以幫助他們從疾病中康復，避免更高和更昂貴的護理，並過上更健康的生活。​​ 

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:​​ 

• 扩大 ECM 福利的覆盖范围，自 2024 年 1 月 1 日起，更多 POF 将有资格享受 ECM，并增加全州每个县可用的社区支持服务数量。​​ 
• 通过 ECM 和社区支持行动计划（包括简化授权和转介流程、扩大医疗服务提供者网络以及改善数据交换），完善计划运营和政策，消除医疗服务提供者签约和服务使用方面的障碍。​​ 
• 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.​​ 
• 举办定期听证会，包括为全州的供应商和社区成员举办 PATH 协作规划和实施 (CPI) 计划工作组，欢迎来自全州供应商和社区成员的不同利益相关者团体对 ECM 和社区支持实施情况的反馈。​​ 
• 鼓励管理式医疗计划通过激励支付计划进一步提高 ECM 和社区支持的利用率。​​ 
• 扩展和利用管理医疗计划合同中要求的各种方法来识别可能从 ECM 和社区支持中受益的成员。 这还包括积极确保签约的供应商网络了解 ECM 福利和社区支持服务以及资格标准，并明确向管理式医疗计划提交转诊的途径。​​ 
• 确保面向公众的管理式医疗计划网站、会员手册和提供商目录包含有关所提供的 ECM 和社区支持以及如何访问它们的最新信息。​​ 

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 在为加州人提供建设更健康、更公平的州所需的医疗服务方面处于全国领先地位。​​ 

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