Focus on CalAIM – February 2023 Digest
California Health Care Foundation
Improving California's health care system, so it works for all Californians.
Note: see the original version of the newsletter here: createsend.com/t/y-18A177E0ED5907A72540EF23F30FEDED
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A new statewide poll?released by CHCF ?last week has some noteworthy implications for?CalAIM. The survey finds significant numbers of Californians?remain deeply concerned about a host of health issues — from the rising cost of care to concerns about access to mental health services to worry about experiencing homelessness. The poll also provides a new window into how acutely people feel?our health systems’ weaknesses, especially when it comes to serving older adults and others with chronic illnesses or disabilities. In an article on The CHCF Blog ?that accompanies the poll, my colleague Kate Meyers ?describes how CalAIM’s reforms are poised to significantly expand the support system for older Medi-Cal enrollees and make long-term services and supports more consistent statewide.?
I enjoyed seeing many of you at the Insure the Uninsured Project conference earlier this month and was filled with hope hearing about how hard people are leaning into implementing CalAIM.
With gratitude,
Highlights
With approval from the federal government, California will now be able to extend Medi-Cal services to incarcerated Californians in the 90 days prior to their release to help connect people to care and services upon reentry to the community.
A major pain point for community-based organizations and other providers new to managed care has been navigating the process to get paid for services they deliver. A new CHCF publication shares some tips and recommendations. In addition, the California Department of Health Care Services (DHCS) launched a new Technical Assistance Marketplace to help providers, community-based organizations, counties, and others get the CalAIM support they need.
Starting in 2024, all California Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage plan, will be required to include palliative care.
California earns federal approval to extend Medi-Cal services to people before they leave jails and prisons
“Getting out of prison is terrifying.”
That’s how one former California inmate, Nisi Marie Wilder, described the fraught period immediately after she was released — without access to health care or social services or a job. More than 400,000 adults and youth are released from California prisons and jails each year. In the first two weeks, they are 12 times more likely to die than others due to the increased risk of experiencing a fatal overdose or other health issues.
“That is when you’re ripe for relapse, when you’re facing these giant challenges in your life,” Wilder says in a new article on The CHCF Blog ?about her challenges trying to maintain sobriety, along with access to services and medication while waiting for Medi-Cal benefits to be activated. “I was lost, completely lost,” said Wilder.
CalAIM will soon give community health care providers some of the tools they need to serve as a bridge for people like Wilder. Late last month California became the first state in the nation to receive federal approval to extend Medi-Cal services to Californians inside prisons, county jails, and youth correctional facilities in the 90 days prior to their release. Authorization for these pre-release services is one of a number of changes that aim to improve health care for people leaving jails and prisons. As of January 1, 2023, all jails must enroll people leaving incarceration in Medi-Cal upon release. (Prisons and youth facilities already had this requirement.) In addition, in January 2024 all people leaving incarceration will become eligible for the Enhanced Care Management benefit .
Under the CalAIM Justice-Involved Initiative , beginning in 2024, county jails, county youth correctional facilities, and state prisons will:
Engage with people who meet specific criteria (e.g., people who have a chronic illness or behavioral health needs, or are pregnant, and everyone in youth facilities) to assess their health and social needs, stabilize their health, and provide intensive care management.
Provide “warm handoffs" to health care providers to ensure people who require behavioral and other health care services, medications, and other medical supplies (e.g., a wheelchair), have what they need upon re-entry to the community.
Make Community Supports (such as housing supports or medically tailored meals) available upon re-entry if offered by their managed care plan.
The final waiver approval also includes $410 million in federal expenditure authority through the Providing Access and Transforming Health (PATH) initiative to support implementation of these programs.
“The biggest way to help people stay out of prison is to help them form new bonds, new connections, new habits,” Wilder wrote in the CHCF blog post. “And a huge part of that is having the resources to turn to. . . . I think these new Medi-Cal policies are a great start to closing the gaps.”
>> DHCS has more information on its website about the CalAIM Justice-Involved Initiative and the services covered . The state also has published a Stakeholder Toolkit ?with FAQs on the program and resources for spreading the word through social media. CHCF supported the Health and Reentry Project (HARP) which produced?two issue briefs ?exploring policy changes regarding the reentry population.
>>The podcast Tradeoffs looks at the new rules in California ?for Medicaid coverage for people before leaving incarceration as well as the 14 other states seeking to follow California’s lead.?A recent Los Angeles Times story ?highlights the program’s potential. Learn more about applying for implementation grant funding through the Justice-Involved Capacity Building Program . ?
Billing questions? New resources now available on billing through CalAIM
One of the biggest barriers for new providers of CalAIM’s Enhanced Care Management and Community Supports program is also one of the most basic: learning how to bill for their services.
A CHCF issue brief published this month shares the nuts and bolts on CalAIM billing , from requesting authorization from a managed care plan to submitting a claim. The brief also includes recommendations from interviews with county providers, community-based organizations, and managed care plans — who share some of the challenges at each stage of the billing process and ways to address them.
More information is available in a webinar recorded earlier this month that featured panelists sharing their own approaches to billing: People Assisting the Homeless, a large multi-region homeless services provider uses a clearinghouse and outsources billing to a third party, while Ceres, a medically tailored meals provider, uses billing software and staffs revenue cycle management in-house. El Sol, an asthma remediation provider, manages billing manually across three plans but with relatively low volume.
In addition, DHCS has launched a new Technical Assistance Marketplace as a one-stop-shop website to help providers, community-based organizations, counties, and others to obtain the resources they need. Notably, organizations do not need a contract with a managed care plan to be eligible for technical assistance.
>> Read CHCF’s issue brief, Billing Better in CalAIM , which includes a helpful flowchart on the CalAIM billing process, or watch the February webinar . Providers can register now for support through DHCS’s new Technical Assistance Marketplace .
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Palliative care access expanding for enrollees who qualify for both Medi-Cal and Medicare
In 2018 Senate Bill 1004 ?went into effect and expanded palliative care access for Medi-Cal enrollees. Palliative care is specialized medical care focusing on relieving the stress and suffering of a patient’s serious illness, often provided alongside other treatments. The goal is to improve the quality of life for both the patient and their family members.
The problem is that people eligible for both Medicare and Medi-Cal (“dually eligible” enrollees) weren't covered by the Medi-Cal requirements — even though many of them would benefit from palliative care based on their higher prevalence of serious illness. As a result, many people have not had access to this crucial care.
DHCS will soon require an expansion of palliative care to reach some dually eligible enrollees. Starting in 2024 all California Dual Eligible Special Needs Plans (D-SNPs) will be responsible for providing and coordinating palliative care referrals and services.?This change ensures that more dually eligible enrollees will have access to palliative care services.
>> See the DHCS website for information on D-SNPs .?Read California’s 2024 contract and policy guide for these plans and existing requirements for Medi-Cal palliative care . CHCF has a resource center ?for plans and palliative care providers looking for ways to work together.
Other CalAIM Articles and Resources We Recommend