For the over six million Californians aged 65 and over, and the over seven and a half million with a disability, getting the care they need has not always been easy.
To help these Californians live healthier lives in their own communities, Medi-Cal — California’s version of Medicaid — has new programs including integration with Medicare; elimination of asset limits restricting eligibility; enhanced care management; and expanded community services like housing aid and healthy meals.
At a Wednesday, July 10 Ethnic Media Services briefing, Department of Health Care Services officials and community health care providers explained what new programs are available to older and disabled Californians, how they’re implemented on the ground and how these programs are changing lives.
An overview
Nearly 6 million Californians, or 15% of the state’s population, were aged 65 and older as of 2021 according to the U.S. Census — a number projected to grow to over 8.7 million, or 20% of the state, by 2030.
The CDC reports that over 7.6 million Californians have a disability.
Dana Durham, DHCS Managed Care Quality and Monitoring Division chief], said Medi-Cal is helping older and disabled Californians through Community Supports and Enhanced Care Management (ECM), programs that “meet social drivers of health” — like housing, healthy food, language access, and preventative health care — “in people’s communities so they can stay in the least restrictive setting possible.”
Community Supports include medically tailored meals, transportation to and from appointments, in-home care, home accessibility modifications, long-term care transition assistance, mental health care, substance abuse disorder treatment and housing aid.
“Historically, the healthcare system has been difficult to navigate,” particularly isolating seniors and people with disabilities, Durham continued.
With ECM, introduced in January 2022, high-risk members or those with complex needs — for example, overlapping issues of dementia, mental health, and daily living — are assigned a lead care manager to help them navigate the system and access Medi-Cal services. These care leads can travel to meet the member if need be; for instance, the patient is homeless, disabled or isolated.
For Californians eligible for both Medi-Cal and Medicare, the federal insurance program for seniors and some younger people with disabilities, there are also now dual Medi-Medi Plans in 12 counties that cover copays and services across both programs, said Anastasia Dodson, DHCS deputy director of the Office of Medicare Innovation and Integration.
In 2026, Medi-Medi will be available statewide.
Currently, of the 6.6 million Californians on Medicare, 1.6 million are also on Medi-Cal.
Dodson added that in January 2024, Medi-Cal eliminated asset limits, meaning that bank accounts, property or a second car won’t affect eligibility; now, only income and household size count.
Community perspectives
Since this expansion of Medi-Cal began in 2022, “We went from three counties to nine statewide where we provide ECM and connection to community supports like doctors, caregivers, meals, transportation, residential care away from nursing homes, home accessibility modifications, housing navigation and rent aid,” said Jenna LaPlante, senior director of care management programs at the Institute on Aging, which serves about 1,000 Medi-Cal members.
“It’s more than we’ve ever served, and we’re in talks with health plans to expand more,” she continued. “Hiring bilingual, bicultural staff from the communities we serve has been key to reaching communities who weren’t historically engaging with our services.”
“For example, we hired a Vietnamese-speaking care manager who went to community centers in San Jose and Santa Clara counties where there’s a large population. We got a huge influx, and could hire more VIetnamese-speaking staff, which increased referrals even more,” LaPlante explained. “We’re now doing the same thing in Merced County, posting jobs for Spanish-speaking staff.”
“This recent expansion to use Medicaid dollars for social determinants of health, like first month’s rent and a security deposit, is incredibly novel. I don’t see it anywhere else,” she added. “Each state can apply to waive how they use federal dollars for more than just medical services. Some do and some don’t … but here in California, we’re at the forefront.”
With older and disabled Californians, health risks often overlap across many areas of life, not just physical health concerns — for instance, if “they’re homeless with no income, no food, and they need a wheelchair,” said Carrie Madden, program director of Aging and Disability Resource Connection of Central and South LA (ADRC), a social service counseling and referral organization.
“What’s really been helpful is being able to coordinate and refer them to services that address these different areas,” she continued. “We have no wrong door. People who call us will get some kind of referral … and we follow up to make sure they get the services they need to live out of nursing homes and treatment facilities, back in the community they came from … With the Medi-Cal change now, we’re seeing individuals get this help much faster.”
ADRC is partnered with Communities Actively Living Independent and Free (CALIF), one of 28 independent living centers in California.
Keith Miller, executive director of CALIF, said “Recently we entered a contract with an insurance provider to provide these new Medi-Cal programs like housing navigation or retention, assistive technology and ongoing case management,” particularly for people frequently entering emergency rooms.”
At CALIF, where “51% of our staff are people with disabilities,” this transformation of Medi-Cal crucially helped “keep our clients out of institutions and nursing homes,” he added.
Lilly Sanchez, case manager at CALIF, shared the story of how this transformation changed the life of one high-risk client who was often in the ER and about to enter a nursing home before he was referred to CALIF, which helped him enroll in Medi-Cal and stay in his community over the course of three months.
“When he came to us, he didn’t have in-home support, no California ID, couldn’t transport himself to and from the services he needed,” she explained. “We were able to do the paperwork for him and coordinate our social services with medical care through the insurance plan.”
“Because of that coordination of care, he is currently housed, he has in-home support, he has food nurtures him to stop needing the emergency room as much as he was before,” Sanchez continued.
“This speaks to how important it is not only to have medical care available but to coordinate it with all the other social services people need to be healthy,” she added. “Medi-Cal is making that coordination possible.”
