California is on the national front lines of public health, transforming Medi-Cal to include services well beyond the doctor’s office.
On April 11, Ethnic Media Services, California Black Media, and the Department of Health Care Services (DHCS) hosted a briefing featuring a DHCS official, community providers and health care workers statewide to discuss how the transformation of Medi-Cal is improving the lives of Medi-Cal members
Speakers at this first of six briefings sponsored by DHCS shared how Medi-Cal is bridging health gaps on the ground by connecting communities to new services that go beyond the doctor’s office — like housing supports, home accessibility modifications, in-home care, sobering centers, asthma remediation and medically tailored nutritious meals.
New services
For 15 million Californians — roughly one in three — currently enrolled in Medi-Cal, this transformation is now bringing health care where they are through Community Supports services and the Enhanced Care Management (ECM) benefit.
Community Supports “keep people out of costly emergency rooms or institutions and support them in their homes and communities, helping them in their place of need,” said Sarah Brooks, Chief Deputy Director for DHCS Health Care Programs.
ECM “supports Medi-Cal members with the most complex physical, mental or social needs — who often who are too sick or impaired to keep track of doctor’s appointments and prescriptions — by assigning them a single lead care manager to help them navigate services like basic care, dental, mental health, substance use disorder treatment and long-term care, as well as equipment and transportation,” said Brooks.
“These are at-risk individuals, including people experiencing homelessness, foster youth, pregnant women and their children, adults at risk for long-term care institutionalization and people transitioning from nursing home care facilities back into the community,” she explained.
“Health systems can be burdensome to navigate, and we’re working hard to revolutionize that by simplifying and broadening how members across the state access care, helping them live more independently and safely at home — no matter where they live, what language they speak, or the complexity of their needs,” Brooks added.
Expanding Medi-Cal on the ground
“For the state to say, ‘Everyone deserves health’ is one thing, but to invest in the lives of a third of Californians is another,” said Rachelle Grant, senior clinical director of Pacific Clinics.
“Other health plans and states aren’t doing this,” she added. “As the state’s largest nonprofit community-based behavioral health service provider, we now have more referrals than ever in the history of our organization, including 27,000 outreaches to eligible members since the start of ECM” in January 2022.
Pacific Clinics now provides ECM and Community Supports services in 20 counties. Community Supports they offer include housing services, such as deposit and move-in loans up to $6,000, landlord and roommate facilitation, household maintenance navigators and daily skills habilitation programs — to ever-growing success.
“One member was unhoused and hospitalized for mental health concerns, with a history of substance abuse that required Suboxone treatment, and a traumatic brain injury that resulted in surgery,” said Grant. His ECM manager found him “residential placement to work on his substance use, a therapist, a psychiatrist and transportation to his appointments. Now he’s going on daily walks, playing pickleball and having positive relationships with caregivers.”
“Our street outreach team discovered another individual living in a tent who shared that he was unable to get a job due to an injury, but he also didn’t qualify for disability. He called into our first day of rehabilitation Zoom classes from his tent, and learned new skills to help him find shelter,” she continued. “There’s no wrong door to get these services — it’s about meeting people’s needs where they are.”
The pandemic proved that “community health workers who speak the language, who are trusted by the community, are the first responders for linguistically or culturally isolated people,” said Agnes Hajek, director of health equity services for Somali Family Services of San Diego, which serves refugees and immigrants from several regions, including the Middle East, Haiti and north and east Africa.
Typical of the organization’s culturally tailored Medi-Cal services is its asthma remediation program in which community workers provide supplies like air purifiers, humidifiers, pillowcases, and mattress covers; inspect homes for mold; develop asthma plans in several languages; and gather support groups to address symptoms.
“Growing up in South Central Los Angeles to Mexican immigrant parents, I’ve seen firsthand the barriers our community can face when trying to access care,” said Angelica Rodriguez, Program Manager of Umma Community Clinic, which serves low-income, predominantly brown and Black populations in the area.
“There are so many ways we can fall through the cracks. Some can’t afford to take time off work when health centers are open nine to five on weekdays. Others can’t seek care due to language or cultural barriers, or having to take multiple buses to get to the closest clinic. Some can’t afford nutritious foods to help them stay healthy,” she said. “Now, we can address these issues beyond the clinic walls.”
Neglect by, and low trust in, care systems is a widespread barrier to health in rural California, said Mari Perez-Ruiz, Executive Director of Central Valley Empowerment Alliance (CVEA), serving a 40 percent Filipino and 99 percent farmworker population primarily in Tulare County.
Geographical challenges also worsen this access barrier, as “we don’t have public transportation for medical appointments. We have two buses that come when they can, one in the morning, one in the evening,” she continued, adding that Medi-Cal lets CVEA bridge these access gaps by bringing care to those least reached and most in need of it.
Through partnering with Tulare County Public Health, CVEA health workers “bring these new services into rural communities,” Perez-Ruiz explained. “We do street medicine with farmworkers by their houses, mobile blood pressure checks, Medi-Cal enrollment help, preventive care with children to break the cycle that leads them to feel uncomfortable going to the doctor, and connect people to shelter.”
“Many farmworkers don’t get the health care they need because they’re too busy worrying about how they’re going to get their next meal on the table,” said Aide Hernandez, a CVEA rural health equity organizer who implements community outreach for these services.
“Community members have come in, not knowing they have a serious condition,” she added, “and the following day, they’re diagnosed with diabetes, they have a limb removed, and they’re in a very serious place because they didn’t get preventive care. To be able to connect these families to this expansion of services is life-changing and life-saving.”
