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California’s Medi-Cal Transformation Addresses Social Needs for Unhoused Citizens


As the Department of Health Care Services (DHCS) transforms Medi-Cal, California is making the nation’s most ambitious effort to address social needs, like housing and at-home support, through health care. This multi-year initiative, which provides insurance for one in three — or 15 million — Californians, now includes social services geared to the health of people at risk of homelessness.

These new programs go well beyond the doctor’s office, like homelessness prevention, housing transition and tenancy navigation, rent and deposit aid, post-hospitalization recuperative housing, sobering centers, day habilitation, and street medicine.

At this briefing by Ethnic Media Services, DHCS leaders, community providers, and healthcare workers will share how they’re using Medi-Cal to help Californians experiencing homelessness and housing instability lead healthier lives.

This is the second in a series of briefings exploring the dramatic Medi-Cal transformation underway.

Glenn Tsang, Policy Advisor for Homelessness and Housing, California Department of Health Care Services said that in the ongoing battle against homelessness, the landscape of medical care is undergoing a profound transformation. 

“This shift isn’t just about medical services; it’s about meeting the unique and pressing needs of those experiencing or at risk of homelessness. The efforts of dedicated individuals like Amber and Brian are at the forefront, making tangible differences at ground level,” Tsang said during the briefing. 

The crux of this transformation lies in the strategic reimagining of medical care to cater to the circumstances of its members. By focusing on those enrolled in medical managed care plans, the aim is to provide support precisely where it’s needed most. 

One key aspect of this approach is reaching members in their environment, be it shelters or unsheltered living conditions. Building community networks attuned to the needs of homeless individuals is paramount. These networks foster trust and facilitate the vital relationship between members and the healthcare system.

Moreover, this transformation involves identifying and addressing the root causes of poor health outcomes, including the social determinants of health. Homelessness, a glaring example of such a determinant, forces individuals to make tough choices between basic needs like food and shelter, directly impacting their health. 

Initiatives like enhanced care management and community support are instrumental in this endeavor. Enhanced care management assigns a lead care manager to coordinate comprehensive care, addressing not just medical but also behavioral health needs. Community supports, on the other hand, offer vital services such as housing transition navigation and housing sustaining services, aimed at providing stability and support to those in need.

By providing care in the community through community-based providers, the focus shifts from expecting members to find their way to the doctor’s office to bringing services directly to them. This approach not only improves access but also fosters trust and strengthens connections within marginalized communities.

Amber Middleton, Director of the HOPE Program, at Shasta Community Health Center, explained one of the cornerstone programs of the center is the SARA program, which includes a mobile medical component. This innovative approach involves parking and fixing sites in areas frequented by the unsheltered population, ensuring accessibility to essential medical services.

In addition, the street medicine program, with 2,351 individuals enrolled, exemplifies the center’s dedication to reaching individuals where they are. This program provides health and social services tailored to the specific needs of those living on the streets.

Furthermore, the medical respite program, operational since 2020, offers a haven for individuals in need of short-term housing and medical supervision. Transitioning into a community support service, this program has become a vital resource for individuals seeking stability and support.

The center’s commitment to accessibility is further underscored by its operation of a clinic within the local homeless shelter. By establishing access points in various areas, the center ensures that individuals in need of care can readily access the services they require.

“Enhanced care management (ECM) lies at the heart of our approach at Shasta Community Health Center. We believe in proactive outreach and support for the population we serve. Through ECM, our dedicated case managers work hand in hand with our clients to address systemic barriers and advocate for their needs, ensuring equitable access to care for all,” Middleton said. 

However, challenges persist in reaching certain segments of the homeless population. Despite efforts to expand services, outreach to homeless youth and families remains a priority, with many individuals staying hidden due to fear of investigation or discrimination.

Founded in January of 2022, the UCLA Homeless Healthcare Collaborative effort led by Brian Zunner-Keating, MS, RN, aims to promote health equity by bringing high-quality medical care directly to the streets of Los Angeles County.

“Since our inception, we’ve provided over 9,000 clinical evaluations to nearly 5,000 unique individuals,” states Zunner-Keating. “We started with 2 teams, and we’ve now expanded to 5 teams, with plans for further growth later this year.”

The collaboration brings together a multidisciplinary team of doctors, nurses, social workers, psychiatrists, and community health workers to deliver essential medical services to individuals experiencing homelessness. “Our program and others like it bring medical professionals and supplies directly to those who need it most,” adds Zunner-Keating.

The key to their success lies in the deep connections they forge with the community. “We rely heavily on partner organizations and employ community health workers who are deeply rooted in the neighborhoods we serve,” explains Zunner-Keating. These workers play a vital role in identifying individuals in need and establishing trust.

Zunner-Keating emphasizes the importance of building genuine connections with those they serve. “We’ve found that making a true human connection is often more effective than simply offering medical care,” he says. “Whether it’s a warm smile, a simple conversation, or asking for help, these interactions lay the foundation for meaningful relationships.”

The impact of their work is evident in the stories of transformation they witness every day. From providing basic medical care to facilitating access to essential resources, the collaborative’s efforts have changed lives. Zunner-Keating recalls the story of an elderly gentleman living in an alley, barely able to walk or see. Through their intervention, he received the medical care and support needed to transition into housing and regain his independence.

Despite the challenges they face, Zunner-Keating remains committed to their mission. “Street medicine has a long history, but the scale of homelessness in Los Angeles demands innovative solutions,” he says. “Our work isn’t always easy, but every one of us feels honored to make a difference in the lives of our homeless neighbors.”

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