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DHCS Unveils Groundbreaking Medi-Cal Overhaul to Boost Health Equity

-Editorial

The Department of Health Care Services (DHCS) is transforming Medi-Cal so Californians can get the care they need to live healthier lives. Medi-Cal members now have access to new and improved benefits and services that go beyond the doctor’s office or hospital and address their medical and health-related social needs. 

For example, Enhanced Care Management (ECM) is a new benefit that provides person-centered care management to members with the most complex needs. Community Supports aims to improve Medi-Cal members’ overall health and well-being by addressing both medical and social factors that can impact a person’s health through programs like housing support, home accessibility modifications, in-home care, sobering centers, asthma remediation, and medically tailored nutritious meals.

At this Ethnic Media Service briefing, DHCS leadership will discuss the Medi-Cal transformation and the multi-year initiative to create a coordinated. enhanced and equitable system of care. Additionally, Medi-Cal community providers and healthcare workers will share what EMC and community support, bridging the health information gap on the ground. This is the first in a series of briefings that will explore the dramatic Medi-Cal transformation underway.

Sarah Brooks, the newly appointed Chief Deputy Director for Healthcare Programs at the Department of Healthcare Services (DHCS), recently discussed significant transformations underway within California’s medical system, known as Cal AIM (California Advancing and Innovating Medical).

In her comprehensive overview, Brooks outlined the department’s strategic enhancements designed to overhaul the traditional medical delivery system, ensuring it better serves the diverse needs of Californians. She highlighted DHCS’s shift toward a holistic approach, integrating physical, mental, and social health services to provide comprehensive care outside conventional medical settings.”Through these initiatives, we aim to simplify the complexities of the health system, making it more accessible for all Californians, regardless of where they live, their language, or their health needs,” Brooks stated.

Among the major introductions is the Enhanced Care Management (ECM) program, which aims to aid members with the most complex cases. This initiative assigns a care manager to help coordinate the myriad aspects of a patient’s care, addressing those who are typically in the top 1-5% in terms of healthcare needs. Brooks also touched on the addition of Community Support, an innovative effort to mitigate health-related social needs that can often lead individuals to require more intensive medical care. These supports include interventions like home modifications, mold removal, and transitional services for those unable to return home immediately after hospitalization.

Moreover, DHCS has standardized medical care across the state through a rigorous new medical managed care contract that took effect earlier this year. This contract aims to equalize the care all Californians receive, eliminating discrepancies that previously existed between different counties and health plans.”

This transformation not only standardizes benefits but also improves the coordination of care by mandating collaboration between health plans and various local agencies such as health departments and school systems,” Brooks explained. The department’s comprehensive approach extends to behavioral health, aiming to integrate services more closely with physical health care and ensure continuity of care through provisions allowing patients to retain their current providers during transitions between plans.

Brooks concluded by reminding the audience of the expanded enrollment qualifications which have significantly increased the number of Californians eligible for Medi-Cal.”Every Californian should know that these improvements are designed with their health outcomes in mind, aiming to create a more inclusive and effective system,” Brooks added, stressing the importance of community awareness regarding these beneficial changes.

Rachelle Grant, Senior Clinical Director, Pacific Clinics said that California’s Leading Behavioral Health Nonprofit Spearheads Innovative Medical Transformation California’s largest community-based behavioral health nonprofit, employing over 2,000 individuals statewide, is at the forefront of a revolutionary approach in medical and housing support services, setting a new standard for health care across the nation. 

The nonprofit provides services in more than 22 languages to diverse age groups across the entire behavioral health spectrum, from early prevention to crisis intervention. Their efforts are part of a broader commitment to ensure that every Californian has access to the health and wellness services they deserve, a vision strongly supported by state funding and innovative policies. 

Highlighted at a recent national conference, the organization’s approach has been noted as uniquely progressive compared to other states. “It’s truly innovative. We’ve been pioneers in this for a while now, Grant said, emphasizing California’s lead in integrating comprehensive health strategies. Central to their strategy are the Enhanced Care Management (ECM) and Community Supports (CS) programs, which have significantly expanded since their initial pilot phase in early 2020. 

The organization now operates these programs across 20 counties and partners with eight health plans. Their services are tailored to various specialty populations, including individuals experiencing homelessness, frequent hospitalizations, and those with mental health and substance use challenges. 

A notable aspect of their work includes housing support services, where they assist clients with everything from finding housing and securing deposits to maintaining stable living conditions. The nonprofit’s ability to offer $5,000 to $6,000 to help new tenants settle in reflects a groundbreaking support system not seen elsewhere. Their efforts have led to remarkable success stories, such as the transformation seen in clients who moved from homelessness to stable residential environments where they can continue their recovery and rehabilitation. 

“Our street outreach team discovered someone living in a tent who, through our support, was able to engage in positive activities and work towards securing housing,” Grant added, underlining the real-world impact of their initiatives. The organization currently serves 1,600 clients statewide under ECM and an additional 600 in their CS housing programs. The inclusion of peer services, leveraging individuals with firsthand experience of the mental health and justice systems, has also enriched their service delivery, making it more relatable and effective.

With ongoing support from the Department of Health Care Services (DHCS) and various health plan partners, the nonprofit is optimistic about the future. They are particularly excited about the prospects for more refined and innovative care approaches in the coming years and the continued expansion of provider networks. For California residents in need, accessing these services requires enrollment in Medi-Cal and contacting health providers or health plans. This integrated approach ensures that there is no wrong door to accessing necessary services, truly embodying the spirit of medical transformation.

“We are witnessing an unprecedented scale of outreach and engagement in behavioral health services, impacting lives positively across the state,” Grant concluded.

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