Aw

Issue Brief

CHCF

 

AUGUST 2022

by Center for Health Care Strategies,
Decipher Health Strategies, Chapman Consulting

Easing Transitions: CalAIM's Changes for
California's Older Adults and People with Disabilities

ver two million seniors and people with dis-

abilities (SPDs) on Medi-Cal in California will

be impacted by the various reforms, initia-
tives, and new policies being developed through
CalAIM (California Advancing and Innovating Medi-
Cal). In particular, one overarching goal of CalAIM is
to streamline and create uniformity across the state
and counties in terms of services, eligibility, benefits,
and delivery systems. Currently, there is significant
variation across counties in the organization and deliv-
ery of health and social care for SPDs in California.?
There is also a great deal of complexity, with enrollees
in some counties interfacing with multiple delivery sys-
tems and programs with various points of entry and
differences in eligibility criteria. As CalAIM seeks to

reduce this complexity in the long term, in the short
term it will involve moving or transitioning SPDs into
new or consolidated delivery systems and programs.

This issue brief describes key care delivery transi-
tions that will impact SPDs during implementation
of CalAIM, and considerations for transitioning SPDs
into new delivery systems with a focus on addressing
health equity by engaging consumers and educating
providers. As the Department of Health Care Services
(DHCS), Medi-Cal managed care plans, and provider
organizations work together to engage SPDs in these
new systems and programs, the information in this
issue brief could inform their approach.

Delivery System Transitions Under CalAIM Impacting SPDs

Under CalAIM, several policies and new initiatives shift SPDs into new programs and delivery systems. Following is a sum-

mary of potential care delivery transition impacts to SPDs as CalAIM moves forward.

Health Homes Program and Whole Person Care Pilots ® Enhanced Care Management

> Phase I, January 1, 2022. As part of CalAIM, California launched a new statewide comprehensive care management

program for Medi-Cal managed care enrollees called Enhanced Care Management (ECM).* In the first phase, which

began January 1, 2022, Medi-Cal managed care enrollees receiving care management through Whole Person Care
(WPC) Pilots (23 counties) or the Health Homes Program (HHP) (12 counties) who also met the ECM population of
focus criteria (PDF) were transitioned into ECM.° (Additional ECM-eligible Medi-Cal enrollees in these counties could also
receive ECM services, even if they had not participated in WPC or HHP) SPDs were included in this first phase if they
were experiencing homelessness, qualified as high utilizers, or if they had serious mental illness, substance use disorders,

or both. SPDs in non-HHP or WPC counties who met the populations of focus criteria for the first phase were eligible to

receive ECM starting on July 1, 2022.
> Phase Il, January 1, 2023. The second phase of the rollout of ECM will impact even more SPDs, including those who
did not participate in WPC or HHP. Beginning in January 2023, eligibility criteria for ECM® (PpF) expands to include
people currently living in institutions who want to transition to lower levels of care; people at risk for institutionalization;

and those transitioning from incarceration.'

Fee-for-Service Medi-Cal ® Statewide Mandatory Enrollment in Medi-Cal Managed Care Plans
> January 1, 2023. While over 1.7 million SPDs are currently enrolled in a Medi-Cal managed care plan (MCP), over
380,000 more SPDs are currently in fee-for-service (FFS) Medi-Cal.° This population includes both SPDs with Medi-Cal
only and SPDs enrolled in both Medi-Cal and Medicare (dually eligible enrollees). Most of these FFS enrollees will be
mandatorily transitioned into an MCP in their county in 2023.' Enrollees will have the opportunity to select a plan; if they
do not, they will default to enrollment in an MCP in their county using an established algorithm that takes into account
continuity of care and MCP quality performance.

Hybrid Managed Care / FFS Institutional Long-Term Care (LTC) Benefit ® Institutional LTC Carved in
to Managed Care Statewide
> January 1, 2023. Over 43,000 Medi-Cal enrollees currently receive care in institutions, including facilities providing

skilled nursing, subacute and intermediate care, and services for people with developmental disabilities.'° In the
31 counties where institutional LTC is not already carved in to managed care, Medi-Cal members are typically disenrolled
from managed care and revert to FFS Medi-Cal after 60 days in the facility. After the LTC carve-in is implemented in
every county, institutionalized Medi-Cal members will no longer revert to FFS and will instead be enrolled in a Medi-Cal
managed care plan.' The statewide LTC carve-in will occur in two phases, with the majority of SPDs in skilled nursing
facilities transitioning on January 1, 2023, and those in facilities for the developmentally disabled or subacute facilities
transitioning on July 1, 2023. For detailed information about the institutional LTC carve-in, see CalAIM and Institutional
Long-Term Care: Lessons for Medi-Cal Managed Care.'*

Cal MediConnect ® Medicare Medi-Cal Plans (formerly called Exclusively Aligned Enrollment Dual Eligible Special Needs Plans)
> January 1, 2023. Currently, nearly 115,000 dually eligible SPDs are enrolled in Cal MediConnect (CMC), managed care
plans that integrate both Medicare and Medi-Cal benefits. These plans were created in seven counties as part of Califor-
nia's Financial Alignment Initiative'? demonstration. In January 2023, these enrollees will be automatically transitioned
into Medicare Medi-Cal Plans (MMPs) - formerly called Exclusively Aligned Enrollment Dual Eligible Special Needs
Plans'* - and Medi-Cal managed care plans under the same parent company (typically the same as the CMC plan).

Nonaligned Medi-Cal and Medicare ® Medicare Medi-Cal Plans

> January 1, 2026. All Medi-Cal managed care plans will be required to launch an MMP (described above). Over 1.5 mil-
lion dually eligible SPDs in California will have the option to enroll in those MMPs.'* People who choose to enroll in an
MMP will also be automatically enrolled in the matching Medi-Cal managed care plan. There are several "matching
plan"'¢ (PDF) scenarios that aim for alignment between Medicare and Med-Cal plans where possible. While Medicare
enrollees will be encouraged to enroll in an MMP, federal rules'" (PDF) require that they continue to have the option to
enroll in a nonaligned Medicare plan or to choose original (FFS) Medicare. The complexity of these enrollment scenarios
could create confusion and complicated transitions for enrollees.

> The MMP program is proposed to be phased in statewide by 2026. However, the DHCS has established a process
whereby plans may request a three-year postponement of the requirement to implement the MMP program to 2029.

Each of the five transitions described above provides major opportunities to improve the consistency, integration, and
effectiveness of care for SPDs - but transitions also come with challenges. In the following sections, some of the challenges
these transitions may present are explored, as well as opportunities to ensure these transitions are as smooth and straightfor-
ward as possible for SPDs, their caregivers, and their providers.
Easing Delivery System
Transitions for SPDs Through
an Equity Lens

A key goal of CalAIM is to advance health equity and
thereby create systems, accountability frameworks,
and services that redress, and don't perpetuate, the
inequities that many Californians face.'® Program tran-
sitions under CalAIM such as those described above
offer both opportunities and potential challenges
regarding equitable care delivery. One of the most
important ways that policymakers can put equity at
the center of program design is to seek out, engage,
and respond to enrollee and provider voices and per-
spectives throughout the design and implementation
of new programs. Along these lines, this issue brief
highlights lessons learned and best practices to focus
on equity and to ameliorate some of the disruption
transitions can present through:

> Communicating with
enrollees

and engaging diverse

» Engaging, educating, and establishing buy-in with
an array of trusted providers

Different Medi-Cal enrollees are vulnerable to tran-
sition-related disruptions in care in different ways. In
addition to engaging consumers and providers, it will
be important for the state to collect accurate data to
monitor the impact that these transitions may have
on enrollees' access to services and health outcomes.
Data on race, ethnicity, language, sexual orientation,
gender identity, and disability status will help policy-
makers, providers, and advocates understand where
inequities may be experienced during transitions and
to address any issues promptly.

Engaging Enrollees and Caregivers to
Promote Effective Transitions

In all the transitions for Medi-Cal SPDs described in
the previous section, it is critical to communicate effec-
tively with Medi-Cal enrollees, their families, and paid

and unpaid caregivers to ensure they have accurate
and understandable information about the coming
changes, how those changes may impact their care,
the choices they have, and the actions they can take.
Below are potential barriers that may hinder effective
communications with enrollees and their caregivers, as
well as best practices to support clear communication.

Barriers

In past efforts to transition SPDs in California to new
services and delivery systems, several barriers and pit-
falls have been identified, including these:

> Notifications and enrollment materials for SPDs
can be complicated, often use jargon, and
are often written at a reading comprehension
level that is too high. Nearly a quarter of adults
in California lack English-language literacy skills
- one of the highest such rates in the country.""
Medi-Cal enrollees with disabilities may face addi-
tional challenges such as blindness or other visual
impairment that impacts their ability to digest writ-
ten information.

> Enrollees may receive conflicting information
from different sources. Enrollees may receive one
piece of information from a state agency but receive
conflicting (or seemingly conflicting) information
from another agency or an enrollment broker. This
was reported in one California county where many
SPD Medi-Cal enrollees received information that
caused them to believe they would be eligible for
the Enhanced Care Management (ECM) program,
only to find out that program eligibility criteria lim-
ited services to select populations with complex
needs."°

> The timing of enrollee communication makes a
difference. If a notice comes too early or too late
relative to the timing of a program change, it can
be less helpful for enrollees. For example, one
MCP reported that they were required to send out
a notice to members about the availability of ECM
six months before the program went live. By the
time the program was available, the MCP found

 

Easing Transitions: CalAIM's Changes for California's Older Adults and People with Disabilities 3
that the information had been forgotten by many
enrollees."

Plans and providers may not share or prioritize
information most important to enrollees. In the
transition from FFS Medicare or Medi-Cal managed
care to the integrated CMC demonstration program
in 2014, many enrollees opted out of CMC plans
because the notification materials lacked key pieces
of information, such as how managed care works,
what new benefits were available, and whether
they would be able to keep their most important
providers."

Mailed notifications and telephone communica-
tions may never reach enrollees. In one survey of
CMC members, only 70% of enrollees remembered
receiving a notification letter about their upcom-
ing transition to that program."? This can happen
for a variety of reasons. One reason is that Medi-
Cal enrollees who live in poverty often face housing
insecurity and can be forced to move often or expe-
rience homelessness, making it difficult for plan
mailings to reach them. They also may not be able
to afford to maintain cell phone service, making it
difficult for the plan to reach them by phone. For
example, one review of a state data set of dually
eligible SPDs found that nearly 30% of the phone
numbers on record were disconnected." Thus,
mailed notices and even phone calls to inform
enrollees of transitions may never reach them.
Another reason is that mailed letters may not be
opened and phone calls from unknown numbers
are often disregarded. With the amount of junk mail
and spam phone calls people receive, a notification
from a health plan or the state may never reach the
enrollee.

Promising Practices

Engaging enrollees and caregivers in the creation of
any new Medi-Cal policy or program is essential to
achieving person-centered and equitable care. This
type of engagement can have immediate and tan-
gible impact when used to inform program design
and the content of and dissemination strategies for
information and communication materials. Below is a
collection of best practices and tools:

>» Engage Medi-Cal SPDs and dually eligible enroll-
ees to learn what matters to them. When planning
fora transition, hearing the opinions of enrollees who
will be impacted can be very helpful in designing the
program, developing communication materials,
and identifying the best communication pathways.
State examples for garnering consumer feedback
include:

When Pennsylvania launched a new Medicaid
long-term services and supports (LTSS) pro-
gram, the state hired an evaluator to perform
a telephone survey of members that identified
preferred engagement activities and communi-
cation pathways before the program launched."

As Massachusetts implemented a new pro-
gram to bring Medicare and Medicaid benefits
into a single plan for dually eligible enrollees
(One Care),2° the state created a consumer-
chaired implementation council?' that included
consumer representatives, community-based
advocacy organizations, and _ representatives
of trade organizations to advise on demonstra-
tion design features. As part of the council, work
groups were formed to address specific topics
including encounter data, long-term services
coordination, and more."8

In Massachusetts the Commonwealth Care
Alliance (an MCP participating in One Care)
developed a Member Voices program,"? a
consumer advisory group composed of people
with disabilities and others. This group reviewed
communications content when the state moved

 

California Health Care Foundation

www.chcf.org 4
certain dually eligible enrollees from FFS into > Test materials with diverse consumers represent-

managed care. The plan continues to engage ing different races/ethnicities, languages, ages,
this group to identify any problems with the pro- education levels, and disabilities. In California,
gram and to maximize accessibility.*° there are at least 13 "threshold languages" that

represent the most commonly spoken languages
of Medi-Cal enrollees. Ideally, consumers who
speak all those languages, including American Sign
Language (ASL), should be engaged in the devel-
opment of materials.** Furthermore, enrollees with
different types of disabilities may absorb informa-
One study focused on California's dually eligible tion differently,?> so diverse disabilities should also
SPDs recommended the provision of patient be represented.

navigators, similar to those required in the
Affordable Care Act, to help SPDs understand
transitions and make the best choice of health
plan, given their specific needs.

In 2016, when focus groups with dually eligible
SPDs revealed that California' CMC program
was difficult for many enrollees to understand,
DHCS revised program materials using feedback
from consumer usability testing.*"

California engaged health literacy experts at
the University of California, Berkeley, to conduct
usability testing of comunication materials for
Medi-Cal enrollees in several languages with a
variety of disabilities.°° Results of the user test-
ing were used to iteratively revise materials so

Improving Notification Materials for SPDs they were understandable in all threshold lan-
Dually eligible enrollees surveyed in California guages and included information important to
had many suggestions for improving written no- the enrollees.

tices and other resources during the transition to
Cle eenneer One study of diverse California caregivers who

were assisting an older adult during a hospi-
tal discharge showed ethnic minorities, recent

> Clarify benefits. Notices should clearly de-
scribe the new benefits they would gain from

the program and any benefits or flexibilities immigrants, and people with limited English pro-
that would be lost if they enrolled. ficiency have unique needs and challenges. This

> Use clear language. Some said that notices study bolstered the evidence of the importance
were unclear, too technical, or vague and of engaging a broad array of diverse enrollees
needed to be written in a way that everyone and their caregivers in the development of com-
could understand. munication materials.*"

> Identify provider status and options for
continuity. Enrollees wanted resources and
simple tools that would tell them whether
their providers were in network and how to
request continuity-of-care provisions for out-
of-network providers.
Source: Carrie Graham, Pi-Ju Liu, and Steve Kaye, Evaluation

of Cal MediConnect: Key Findings from a Survey with
Enrollees (por), UCSF, August 17, 2016.

 

Easing Transitions: CalAIM's Changes for California's Older Adults and People with Disabilities 5
Best Practices for Engaging People with
Disabilites in Research

Many SPDs have physical or behavioral health-
related disabilities that can pose barriers for them to
engage in focus groups, interviews, or surveys. Thus
it is important for any researcher or health care en-
tity to review best practices for data collection with
people with disabilities. The Rehabilitation Research
and Training Center on Disability Demographics and
Statistics (StatsRRTC) has created the Compendium
of Disability Data Collection Methods, an easily
accessible source of evidence-based best practices
and inclusive strategies for collecting data on and
engaging people with disabilities.

Source: Jason Markesich, Stacie Feldman, and William Rafferty,

2020 Compendium of Disability Data Collection Methods,
Mathematica, Jan. 31, 2020.

Engage health literacy experts to ensure materi-
als are understandable and meet plain language
standards. Some Medi-Cal SPDs may have lower
levels of educational attainment - national analy-
ses have found that 43% of dually eligible SPDs
do not have a high schoo! diploma.** This makes
it especially important to ensure appropriate read-
ing levels of written materials. Some disabilities can
also make it difficult to absorb written information,
especially if it includes excess jargon. Working with
experts in health literacy and plain language can
ensure materials are written simply and are easy to
understand and act upon.

Several organizations have developed resources
to make Medi-Cal communications easier
to understand. The California Health Care
Foundation developed a_ resource? with
recommended steps to improve Medi-Cal
communication, and the Center for Health
Care Strategies developed a tool*° with tips to
improve print and oral communication.

In 2009, health literacy experts used participa-
tory design methods involving interviews and
focus groups with Medi-Cal-only SPDs, usabil-
ity tests of materials, and input from consumer
advisory groups to develop and test user mate-
rials for SPDs transitioning to managed care."
Lessons learned from this effort resulted later
in an enrollee toolkit? for CMC enrollees that
included information on available benefits, other
services, how to make appointments, and more.

>» Use a variety of communication pathways and

partners. Consumers are increasingly using tech-
nologies such as the internet, email, and text
messaging to access information.' As part of con-
sumer engagement, enrollees should be queried
about their preferred communication pathways,
with the ability to opt in to text messages, email,
and other pathways if preferred. MCPs and the
state should also be prepared to use phone calls,
in-person communication, and videos to explain
transitions to enrollees. Finally, where possible,
leveraging trusted community partners such as
community-based organizations and Area Agencies
on Aging can be key to ensuring that enrollees get
the information they need.

In Massachusetts, Commonwealth Care Alliance
(an MCP) reached out by phone or through in-
person visits to notify people eligible to transition
into their One Care program for dually eligible
enrollees." This allowed them to ask questions
about the program and get the information that
was important to them before making a choice.

In California, Cal Duals*® provides educational
videos called "Cal MediConnecToons" in mul-
tiple languages including ASL that clearly explain
enrollee choices and options."

In Wisconsin, Aging and Disability Resource
Centers serve as a trusted source of information
where enrollees transitioning into managed care
can talk to a counselor by phone."

 

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www.chcf.org 6
>» Test communications systems before launch. It is

important to make sure that member questions can
be answered in real time and that language and cul-
tural barriers do not influence the information being
provided to enrollees.

The Texas state Medicaid agency used "secret
shopper" strategies to test the ability of call
centers or other member-facing staff to answer
questions before program transitions began. The
state developed scenarios to anticipate potential
enrollee questions and then tested the capacity
of plan staff to respond to those questions."

>» Create systems that allow enrollees to provide

feedback to the state and MCPs in real time.
Creating efficient feedback loops is important so
that the MCPs and states can quickly learn about
any issues and address them efficiently.

When Florida transitioned LTC services to man-
aged care, the state created an online, centralized
complaint form and hub to monitor and respond
to incoming feedback from both members and
providers."

In California during implementation of CMC, the
state employed an independent ombudsman for
dually eligible enrollees to call to report prob-
lems. In the first year alone, the ombudsman was
able to identify over 50 implementation issues
and challenges that were reported to the state
to rectify.°°

>» Ensure that MCP staff, enrollment brokers, and

patient navigators receive training in diversity,
equity, and inclusion. It is essential for all staff to
build skills to recognize and attend to cultural differ-
ences that impact care preferences, communication
methods, or both.

One study of cultural competency in Medi-Cal
plans found that as plans and provider organiza-
tions focused on meeting the needs of specific
linguistic and cultural groups, administrators
recognized the need for more staff education,
and all plans and provider organizations in the
study implemented training programs as a result.
Although these programs focused initially on lin-
guistic needs, all MCPs interviewed commented
that they were developing or attempting to iden-
tify effective programs dealing with other cultural
aspects of health care.°"

The US Department of Health and Human
Services has compiled resources" with informa-
tion on cultural competency related to general
health care delivery as well as specific to individ-
uals with behavioral health needs. Among other
topics, resources outline what cultural respect is,
how to promote it in the delivery of health care
and related services, and National Standards for
Culturally and Linguistically Appropriate Services
(CLAS) in Health and Health Care.

The federal Office of Minority Health created
Think Cultural Health,54 an initiative and a
website that provides health care professionals
(such as physicians, nurses, behavioral health
providers, and community health workers) with
resources and continuing education / online
learning opportunities on cultural and linguistic
competency and implementation of the CLAS
standards.*°

 

Easing Transitions: CalAIM's Changes for California's Older Adults and People with Disabilities 7
 

 

Additional Resources on Cultural

Competency

Agency for Healthcare Research and Quality
Oral, Linguistic, and Culturally Competent
Services

Center for Appropriate Dispute Resolution in
Special Education
Equity and Cultural and Linguistic
Competence - Resources to Consider

Cigna
Cultural Competency Training

Cultural Intelligence Center
Healthcare Bias Training

Georgetown University
National Center for Cultural Competence

Michigan Department of Health and Human Ser-
vices
Public Health Resource Sheet Cultural
Competency (PDF)

 

 

Engaging, Educating, and Establishing
Buy-in with Providers

Providers play a key role in communicating about
transitions with their patients and clients. A person's
trusted provider - whether it's a primary care, behav-
ioral health, specialty care, or LTSS provider - may be
the first place they go to seek information when faced
with a program, service, or delivery system transition.
California providers must be educated about CalAIM
reforms to support their patients during transitions.

Barriers
When it comes to communicating with and educating
providers about transitions, several barriers and les-
sons learned have been noted both in California and
nationally.

> When physicians and other providers lack
awareness of the initiatives, it can be confusing
to enrollees. For example, in one study of CMC
enrollees, many said their providers did not have
sufficient knowledge of the CMC program and the
benefits it covered. This lack of awareness often
resulted in enrollees receiving conflicting informa-
tion from their physician and health plan. In some
cases, this caused disruptions in services.*¢

> All types of providers should be engaged and
educated about transitions. While many provider
engagement efforts related to Medi-Cal may be
aimed at primary care or other medical providers,
SPDs often receive care outside these traditional
medical settings, from social workers, behavioral
health or LTSS providers, and others.

» When states launched their Financial Alignment
Initiative (Medicare/Medicaid integration)
demonstrations, a report from the Centers for
Medicare & Medicaid Services noted that most
outreach was focused on physicians, and there
was little communication to other providers such
as nursing facilities.*"

» In akey informant interview study with providers
in California, physicians reported that it would

 

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have been helpful if other frontline office staff
had received information about the program
due to their role in interacting with and advising
patients.

> When providers are not educated about the ben-
efits of a program, they may explicitly or subtly
encourage enrollees to opt out.

During the transition to CMC there were higher
opt-out rates in certain counties, and it was
believed that some providers encouraged mem-
bers to opt out of the demonstration."

Experiences with or fear of slow payment or of
reimbursement denials can lead providers to
resist becoming managed care providers, and to
encourage their patients to opt out of managed
care and stay in FFS so they can continue to stay
with their current providers.

Promising Practices

Many states have successfully worked with an array
of providers to educate them about changes to pro-
grams or delivery systems, ensuring they have the
information they need to best support their patients
during transitions. Some promising practices include:

» Engage and educate providers - including
clinical and nonclinical staff - before program
transitions. This will help them know what to expect
and be able to share neutral information with their
patients.

In California, a consultant worked to develop
a Physician Toolkit®' to educate providers on
CMC benefits and policies.

In Massachusetts, when the One Care program
began, Commonwealth Care Alliance (an MCP)
proactively reached out to providers to educate
them about the new initiative so the providers
had enough information to share with members
who had questions about the program."

Idaho's Medicaid agency did a series of "road
show" presentations for providers across the

state with its one Dual Eligible Special Needs
Plan, Blue Cross of Idaho, to build trust through
in-person discussions.

Ohio engaged provider associations for more
than a year before the launch of MyCare Ohio
(the state's Financial Alignment Initiative for
dually eligible enrollees) to gain their buy-in
and input. Several provider associations are now
represented on Ohio's advisory committee that
provides feedback to the state on implementa-
tion issues.™

> Reach out to an array of provider types to ensure

that trusted care partners can share information
about transitions. People with complex needs
often receive care from multiple providers and may
rely on paid personal care assistants to help with
activities of daily living.° Because SPDs may use
multiple types of health care and community-based
services, the state and MCPs should go beyond
medical providers to also engage social care provid-
ers, Care managers, and front office staff to educate
them about program transitions.

In California, during the implementation of
CMC, care managers from MCPs shadowed staff
at Community-Based Adult Services (CBAS)*
centers so that both care managers and CBAS
staff were better equipped to explain LTSS ser-
vices to CMC enrollees.®"

In California, a consultant was engaged to cre-
ate a Hospital Case Manager Toolkit®® so that
discharge planners and others could help their
patients in CMC plans understand their options
after a hospital stay.

> Communicate often with providers, with more

intensive outreach up front.

In Kansas, when behavioral health services were
carved into managed care, state staff and health
plans held daily "rapid-cycle response calls" with
providers to deliver live support that decreased
in frequency over time as providers became more

 

Easing Transitions: CalAIM's Changes for California's Older Adults and People with Disabilities 9
familiar with the carve-in program's expectations
and details.

When Virginia implemented a new demonstra-
tion program to serve dually eligible enrollees,
the state held regional town hall meetings to
address provider questions."°

>» Focus provider education and technical assistance
on program design elements most important to
providers, such as workload impacts, staffing,
and billing."

Consider incentives that could help improve
provider satisfaction with the program and incor-
porate those incentives into messaging about
new services (e.g., hours, extra capacity, etc.)."

In CalAIM, MCPs are providing ongoing techni-
cal assistance to providers to ensure that they
understand how to report and bill for services to
avoid reimbursement delays.'3 As CalAIM creates
more opportunities for MCPs to contract with a
variety of provider types for care management
and nonmedical social care, technical assistance
to community-based providers will continue to
be important.

> Create opportunities for providers from different
sectors to communicate, collaborate, and share
information to make sure that members' multiple
needs are met. Many of the transitions in CalAIM
are intended to coordinate care and integrate ser-
vices across several sectors, including medical care,
LTSS in homes and in institutions, behavioral health,
and others. Providers from all these sectors can
benefit from opportunities to form relationships,
share information, and learn from each other.

In a study of California providers in various sec-
tors involved in CMC, many providers stated
that the most useful educational resources were
learning collaboratives and regional coalitions
that were designed to bring providers together,
establish relationships across sectors, improve
communication, and forge shared learning."

In Massachusetts, LTSS providers participate in
interdisciplinary care team meetings to ensure
that other providers and MCP care managers are
aware of enrollees' personal care needs.'

In California, one county agency that had been
administering the Whole Person Care (WPC) pilot
met with MCP care managers who were newly
implementing ECM to explain the details of the
WPC program transition and prepared scripts for
MCPs on the program transition."¢

One California MCP implementing CMC colo-
cated their care coordination staff in the same
offices as county agency staff administering
the In-Home Supportive Services program,"
a Medi-Cal Home and Community-Based
Alternatives waiver program. This allowed the
MCP care coordinators to more readily interact
and spontaneously coordinate care between
medical care and LTSS.

Conclusion

As Californias SPDs experience changes to some
services, programs, and care delivery systems under
CalAIM, the state and MCPs could help smooth these
transitions by engaging enrollees, their caregivers,
and an array of providers before and during imple-
mentation of these changes. Successful practices
from California and other states can inform these
approaches, to optimize person-centered and equi-
table care, minimize disruptions in services, and move
closer to more integrated, better coordinated care for
seniors and people with disabilities across the state.

 

California Health Care Foundation

www.chcf.org 10
About the Authors

Carrie Graham, PhD, is the director of long-term
services and supports and Torshira Moffett, MPH, is
a senior program officer at the Center for Health
Care Strategies, a policy design and implementation
partner devoted to improving outcomes for people
enrolled in Medicaid, including those dually eligible
for Medicare and Medicaid. Hope Glassberg, MPA, is
the president of Decipher Health Strategies, a firm
providing experience at the intersection of health
policy, strategy, and operations to states, nonprof-
its, and technology organizations. Athena Chapman,
MPP, is president; Elizabeth Evenson is senior policy
director; and Samantha Pellén, MPH, is policy direc-
tor at Chapman Consulting, which provides strategic
planning, meeting facilitation, organizational support,
market research, and regulatory and statutory analysis
to organizations in the health care field.

About the Foundation

The California Health Care Foundation is dedicated
to advancing meaningful, measurable improvements
in the way the health care delivery system provides
care to the people of California, particularly those
with low incomes and those whose needs are not
well served by the status quo. We work to ensure that
people have access to the care they need, when they
need it, at a price they can afford.

CHCF informs policymakers and industry leaders,
invests in ideas and innovations, and connects with
changemakers to create a more responsive, patient-
centered health care system.

CalAIM for Seniors and People with Disabilities
is a series of reports focusing on elevating experi-
ences from California and other states to ensure

CalAIM reforms impacting Medi-Cal's seniors and

people with disabilities build on past efforts to
integrate and improve care.

 

Endnotes

1. Medi-Cal Monthly Eligible Fact Sheet (ppp) (Feb. 2022),
California Dept. of Health Care Services (DHCS), May 2022.

2. Giselle Torralba et al., Meeting the Moment: Strengthening
Managed Care's Capacity to Serve California's Seniors and
Persons with Disabilities, California Health Care Foundation
(CHCR), April 2021.

3. CalAIM: New Directions for Services for Seniors and Persons
with Disabilities, Legislative Analyst's Office, March 15, 2021.

4. "CalAIM Enhanced Care Management, Community Supports,
and Incentive Payment Program Initiatives," DHCS, last
modified June 21, 2022.

5. "Whole Person Care (WPC) Pilots," DHCS, last modified
May 23, 2022; "Health Homes Program," DHCS, last modified
March 29, 2022; and California Advancing and Innovating
Medi-Cal (CalAIM): Enhanced Care Management (PpF), DHCS,
accessed June 29, 2022.

6. CalAIM Enhanced Care Management Policy Guide (pPoj, DHCS,
last updated April 2022.

7. Enhanced Care Management: ECM and ILOS Implementation
Timeline, ECM Populations of Focus, ECM Overlap with Other
Programs and Exclusions (ppF), DHCS, accessed May 30, 2022.

8. Medi-Cal Monthly Eligible Fast Facts (ppF) (Jan. 2022), DHCS,
April 2022.

9. Medi-Cal Monthly Eligible Fast Facts (ppp) (Nov. 2021), DHCS,
February 2022.

10. Fast Facts Jan. 2022), DHCS, figure 3.

11. Carrie Graham et al., Cal[AIM and Institutional Long-Term Care:
Lessons for Medi-Cal Managed Care, CHCF, March 2022.

12, Graham et al., CalAIM and Institutional Long-Term Care.

13. Financial Alignment Initiative, Centers for Medicare & Medicaid
Services (CMS), last modified June 1, 2022.

14. Erin Weir Lakhmani et al., Working with Medicare: Using
D-SNPs to Integrate Care for Dually Eligible Individuals (pvr)
(Integrated Care Resource Center webinar, Dec. 17, 2020); and
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15. Fast Facts (Nov. 2021), DHCS.

16. Gretchen Nye et al., CalAIM Managed Long Term Services
and Supports (MLTSS) and Duals Integration Workgroup (PDF)
(DHCS webinar, May 19, 2022).

17. Medicare Managed Care Manual: Chapter 4 - Benefits and
Beneficiary Protections (PDA, CMS, last revised April 22, 2016.

18. Ben Johnson, Corey Hashida, and Ned Resnikoff, The 2021-22
Budget: CalAIM: Equity Considerations, Legislative Analyst's
Office, March 2021.

19. Beccah Rothschild, Plain and Clear: Making Medi-Cal
Communications Easy to Understand, CHCF, January 2022.

20. Key informant interview, March 2022.

 

Easing Transitions: CalAIM's Changes for California's Older Adults and People with Disabilities 11
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MediConnect Key Findings from a Survey with Beneficiaries
(PDF), SCAN Foundation, August 17, 2016; and Kathryn G.
Kietzman et al., Disconnected?: Challenges of Communicating
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November 2018.

Kietzman et al., Disconnected?.

"Quarterly Certified Eligible Counts by Month of
Eligibility, County, and Threshold Language," California
Health and Human Services Open Data Portal, last updated
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Dana Durham (chief, Managed Care Quality and Monitoring
Division, DHCS), "Standards for Determining Threshold
Languages, Nondiscrimination Requirements, and Language
Assistance Services" (ppF), All Plan Letter 21-004, May 3, 2022.

"How Deaf People Read," San Diego State Univ., accessed
June 29, 2022.

Linda Neuhauser et al., "Participatory Design of Mass Health
Communication in Three Languages for Seniors and People
with Disabilities on Medicaid," Amer. Journal of Public Health
99, no. 12 (Dec. 2009): 2188-95.

Carrie L. Graham, Susan L. Ivey, and Linda Neuhauser, "From
Hospital to Home: Assessing the Transitional Care Needs of
Vulnerable Seniors," Gerontologist 49, no. 1 (Feb. 2009): 23-33.

Data Book: Beneficiaries Dually Eligible for Medicare and
Medicaid (ppF), Medicaid and CHIP (Children's Health Insurance
Program) Payment and Access Commission, January 2018.

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Users Has Grown in the Past Decade," Pew Research Center,
January 13, 2022.

Walsh, Financial Alignment Initiative.
Beneficiary Toolkit, CalDuals.

"Educational Videos: CalMediConnecToons," CalDuals,
June 29, 2022.

Jenna Libersky, Cara Stepanczuk, and Rebecca Sweetland
Lester, Medicaid Managed Long-Term Services and Supports:
Themes from Site Visits to Five States, Mathematica,

March 3, 2016.

Alexandra Kruse, Strategies to Facilitate Managed Care
Implementation for Medicare-Medicaid Enrollees (por), CHCS,
June 2014.

Kruse, Strategies to Facilitate.

Amber Christ and Georgia Burke, A Primer on Dual-Eligible
Californians: How People Enrolled in Both Medicare and
Medi-Cal Receive Their Care (pA), CHCF, September 2020.

Molly Coye and Deborah Alvarez, Medicaid Managed Care and
Cultural Diversity in California (PoF-), Lewin Group, March 1999.

"Resources on Cultural Competency," Substance Abuse and
Mental Health Services Administration (SAMHSA), last updated
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(HHS), accessed June 21, 2022.

"Cultural and Linguistic Competency," HHS, last modified
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Carrie L. Graham et al., "Integration of Medicare and Medicaid
for Dually Eligible Beneficiaries: A Focus Group Study
Examining Beneficiaries' Early Experiences in California's Dual
Financial Alignment Demonstration," Disability and Health
Journal 11, no. 1 Jan. 2018): 130-38.

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in California: Provider Perspectives of Cal MediConnect (PDF),
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Sara Barth and Michelle Herman Soper, Engaging Providers in
Integrated Care Programs for Medicare-Medicaid Enrollees:
Tips for States (PDF), Integrated Care Resource Center,
October 2015.

 

California Health Care Foundation

www.chcf.org 12
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Hospital Case Manager Toolkit, CalDuals, accessed May 2022.

Michelle Herman Soper, Integrating Behavioral Health into
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Key informant interview, March 2022,
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2020-21 California Advocacy Network: Community Profiles
(PDA, SCAN Foundation, December 2020.

Key informant interview, March 2022.
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"In-Home Supportive Services (IHSS) Program," California
Dept. of Social Services, accessed May 2022.

 

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13