Building on CalAIM’s housing supports: strengthening Medi-Cal for people experiencing homelessness
- Collection:
- Health Policy and Services Research
- Author(s):
- Rapport, Sharon, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, August 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Community Health Services Financing, Government Government Programs Health Services Accessibility Healthcare Disparities Housing Instability Ill-Housed Persons Medicaid Public Housing Social Determinants of Health State Health Plans California
- Genre(s):
- Technical Report
- Abstract:
- While the health care system cannot by itself solve homelessness, it has a crucial role to play in providing access to services critical to the welfare of people experiencing homelessness. Across the state, organizations and communities help people exit homelessness every day. But the story behind each success is often a long journey through layers of administrative barriers and siloed programs. Navigating access to meaningful care by people experiencing homelessness, who are already facing trauma and struggles to survive, requires a person-centered approach to care. California’s Medicaid program, Medi-Cal, is undergoing an ambitious transformation known as CalAIM (California Advancing and Innovating Medi-Cal). A key focus of this transformation is removing barriers to care for populations who struggle to access services, including people experiencing homelessness. A critical goal of CalAIM is a more person-centered approach to publicly funded health care. This paper rests on a foundation of extensive research and examines the successes, challenges, and opportunities in providing person-centered care to people experiencing homelessness. In Part 1, the authors describe in detail how homelessness undermines a person’s health. When people live outdoors or without reliable shelter, existing health issues are made worse, and people develop new ones. Californians experiencing homelessness die in large numbers from causes directly related to their lack of housing. Homelessness cuts lives short: People experiencing homelessness die on average 20 to 30 years younger than their housed counterparts. Homelessness also exacerbates existing racial health disparities, with Black and American Indian / Alaska Native people being significantly more likely to experience homelessness. Decades of racism in housing and institutional policies contribute to these disparities, leading to untreated chronic health conditions and other behavioral and physical health problems that contribute to chronic patterns of homelessness and early mortality. The primary driver of homelessness is a lack of affordable housing. Part 2 describes opportunities in CalAIM, in the Providing Access and Transforming Health (PATH) initiative, and in the Home and Community-Based Services Spending Plan to fund housing support services that connect people to housing and help keep people stably housed. This section also includes explanations of CalAIM’s Enhanced Care Management benefit (PDF) and Community Supports (PDF), seven of which specifically focus on people experiencing homelessness. Despite the promise of CalAIM and related programs, CalAIM’s impact has been limited to date. Part 3 describes the challenges providers and managed care plans face in implementing CalAIM and the provision of housing support services. Health care and social service providers offering services under CalAIM must navigate differing reimbursement rates - which may not be enough - and differing requirements set by each managed care plan, even among plans operating in the same county. Managed care plans may not know how best to identify and reach people experiencing homelessness, and to connect people to housing and housing support services. Meanwhile, people who are unhoused must still find and access the care and services they need by navigating complex systems of care and fragmented provider networks.
- 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 (57 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918734179406676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918734179406676