How Medi-Cal Is Improving Healthcare Services in California

A Medi-Cal Overhaul

California is leading the way in healthcare reform by incorporating community health workers, improving care administration, and partnering with community-based groups to ensure that everyone’s needs are met.

The state’s Medi-Cal program is undergoing a major overhaul to better serve California’s aging population and those with disabilities by focusing on socioeconomic determinants of health. Medi-Cal aims to enhance health outcomes and quality of life for disadvantaged populations in the state by meeting people where they are, addressing socioeconomic determinants of health, and increasing benefits and services.

Medi-Cal enhances eldercare services

Medi-Cal is investing in efforts to improve healthcare services for older adults and people with disabilities by addressing socioeconomic factors that influence health.

At a July 10 Ethnic Media Services briefing, experts emphasized the significance of tailoring care to each person’s unique needs, tackling housing and mental health as social determinants of health, and increasing access to essential community support services through expanded benefits and services. They also addressed the significance of working with local community-based groups, and the impact of initiatives by the ADRC (Aging and Disability Resource Connection).

Dana Durham, Chief of the Managed Care Quality and Monitoring Division at the California Department of Health Care Services, said, “We’re working to make sure that members have access to preventive comprehensive services that meet their needs before they get sick.”

Connecting with People Where They Are

The panel emphasized that people require care in ways that are accessible and have personal relevance. This includes ensuring that comprehensive and preventative services are available to people and that they are provided in a way that doesn’t interfere with their everyday lives or specific circumstances. In this setting, it is vital said the panel, to address housing, mental health, and economic stability, which are social determinants of health.

An integral part of the revamped Medi-Cal programs is Enhanced Care Management (ECM). ECM will designate a lead care manager when a Medi-Cal patient needs help navigating the healthcare system. These care managers are responsible for helping patients gain insight into their medical illnesses, locating relevant resources (such as mental health and drug abuse assistance), and developing individualized treatment programs. A person’s holistic requirements will be met through the provision of integrated care management.

Working Together with Non-Profit Groups in the Community

Medi-Cal’s transformation has depended on significant partnerships with local community-based groups to provide more services to older adults and people with impairments. The Institute on Aging, for example, has helped thousands of Medi-Cal clients shift to community services, by investing in training bicultural and multilingual workers who can reach out to populations that have been traditionally neglected. This method guarantees cultural competence and individualization of care for all populations.

Carrie Madden, the Program Director for Aging and Disability at Central and South Resource Connection (ADRC) explained that to effectively reach historically underserved communities, “we prioritize hiring bilingual and bicultural staff who reflect the demographics of the populations we serve.”

For example, ADRC hired Vietnamese-speaking care managers in San Jose, which led to a significant influx of clients from the Vietnamese community. Similarly, in Merced County, they focused on hiring Spanish-speaking staff. This targeted approach ensures culturally competent services, builds trust and enhances community engagement.

The effectiveness of Medi-Cal’s reform depends on the cooperation of local groups. These collaborations make the provision of all-encompassing services possible, meeting the varied needs of the elderly and those with disabilities. Keith Miller, the organization’s executive director, emphasizes that Cal AI Community’s goal is to offer assistance to the elderly and those with disabilities. Program Manager Lily Sanchez of Cal Life Direct Services also provided anecdotes about the positive results of from bringing services to healthcare centers.

Aging and Disability Resource Connection (ADRC)

The ADRC plays a key role in providing services such as information and referral, counseling on available alternatives, service coordination, and transitional support when linking people to the services they need. It offers a streamlined process to link callers with the right disability and aging services, with counseling choices and warm handoffs.

Madden stated, “At the Institute on Aging, we have been serving Medi-Cal recipients across three counties in the Bay Area even before the medical changes in 2022. Our focus has been on assisting adults with disabilities, whether they are transitioning from nursing facilities to community living or those at risk of institutionalization who prefer to stay within the community.”

ADRC works closely with Medi-Cal managed care plans to seamlessly integrate new medical services, allowing clients to retain their case managers and continue receiving consistent care. Their efforts emphasize maintaining people in the least restrictive environments they choose, providing essential services such as care coordination and temporary gap coverage for immediate needs.

“Our expansion to nine counties, including San Francisco, San Mateo, Santa Clara, Santa Cruz, Monterey, Merced, Alameda, Riverside, and San Bernardino, has significantly increased our capacity to serve more people. Additionally, they employ community health workers from within the communities to further improve access and support for eligible people.

Community Health Workers

A major change to Medi-Cal is the increased compensation and recognition of community health professionals. These employees, who are frequently residents of the areas they serve, are vital in expanding participation and availability of resources. They can link people in a culturally sensitive way to the resources they need because of their extensive familiarity with the area.

Helping people with disabilities and the elderly gain access to community resources and home adaptations is an important part of improving healthcare for these populations. These adaptations, which may include assistive technology and other services, can help people regain their independence in their homes. A person’s quality of life depends on this assistance, and providers work to ensure that qualified persons may get it.

Housing & Assisted Living

The speakers emphasized the crucial need for housing in the quest to improve overall health outcomes. Some programs assist people in securing permanent housing by covering expenses such as the first month’s rent and security deposits. This assistance is vital in helping people to stay in their homes and communities and avoiding institutionalization.

The Independent Living Center (ILC) offers assistance with housing, benefits, and access to assistive technology. The ILC works with health maintenance organizations (HMOs) and managed care groups to ensure that clients get the treatments they need to stay out of institutions and live independently as much as possible.

Complexity of connection

“Our biggest success and greatest challenge are deeply intertwined, centering around the development of local connections,” said Durham. She emphasized that community-building initiatives were critical for forming connections, strengthening local ties, and fostering a sense of community. We have continuously find new ways to engage and have meaningful conversations, she added, underscoring the importance of inclusivity and representation.

Only by listening to various perspectives could service providers using Medi-Cal funds raise awareness and establish referral procedures and deliver culturally sensitive care to marginalized groups.

“However, this process becomes increasingly challenging. How do we involve more community members and ensure that those who truly understand the community have a place at the table?”

She emphasized the importance of navigating community engagement with sensitivity to everyone’s voice is heard, understood, and incorporated into decision-making.

“This delicate navigation requires ongoing effort and a deep commitment to inclusivity, which remains one of our most significant and continuous undertakings.”

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