CalAIM and institutional long-term care: lessons for Medi-Cal managed care
- Collection:
- Health Policy and Services Research
- Author(s):
- Graham, Carrie, author Glassberg, Hope, author Chapman, Athena, author Evenson, Elizabeth, (Of Chapman Consulting), author Pellón, Samantha, author
- Contributor(s):
- California HealthCare Foundation, issuing body. Center for Health Care Strategies, Inc. issuing body. Chapman Consulting, issuing body. Decipher Health Strategies, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, March 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Institutionalization Long-Term Care Managed Care Programs Medicaid California
- Genre(s):
- Technical Report
- Abstract:
- CalAIM (California Advancing and Innovating Medi-Cal) is a comprehensive, multiyear effort led by the California Department of Health Care Services (DHCS) that seeks to implement broad delivery system, program, and payment reform across California’s Medi-Cal (Medicaid) program. Like many states, California uses managed care delivery systems to administer Medi-Cal. Currently, over 8 in 10 Medi-Cal enrollees are in Medi-Cal managed care plans (MCPs), and this number will increase as CalAIM further expands mandatory managed care enrollment. One CalAIM reform initiative--the institutional long-term care (LTC) carve-in--will require that care in nursing homes and other institutional settings be provided as a benefit through Medi-Cal MCPs state wide as of January 1, 2023. To support the design and implementation of this initiative, this report describes the challenges, opportunities, and lessons learned from (1) California counties where institutional LTC has previously been carved in to MCPs, and (2) other states where institutional LTC has been administered by MCPs. This paper focuses on the experiences of seniors and adults with disabilities, including those with Medi-Cal only and those with both Medi-Cal and Medicare (dually eligible enrollees), synthesizing information from literature reviews and interviews with both California and national experts, and describes opportunities to design a system that achieves the following: (1) Improves access to appropriate institutional care for those who need it (2) Promotes care in home and community-based settings and diverts care away from institutions when possible and desired by the person receiving care (3) Promotes higher quality of care in institutional settings (4) Addresses equity and care disparities in California’s LTC services This report is intended to inform state officials, MCP leaders, institutional LTC providers, community providers serving individuals with LTC needs, and advocates, who will all play unique roles as this policy moves forward. Specific takeaways for these audiences are highlighted in the conclusion.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (26 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918573685706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918573685706676