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-Editorial
As the Department of Health Care Services (DHCS) continues to transform Medi-Cal, DHCS is working to ensure older adults and people with disabilities have access to quality, equitable care. DHCS has expanded several programs that provide this expanded care and assistance, including medically tailored meals, transportation to and from appointments, in-home care, home accessibility modifications, and long-term care transition assistance.
For older adults and people with disabilities who are eligible for both Medi-Cal and Medicare, there are now dual Medicare Medi-Cal Plans available in 12 counties that integrate these services across both programs. Additionally, the recent expansion of Medi-Cal and elimination of asset limits — like bank accounts, property, and a second car — help more people qualify for Medi-Cal coverage.
During this briefing by Ethnic Media Services, DHCS leaders and community healthcare providers will shared how these Medi-Cal programs are helping older and disabled Californians live healthier lives at home.
This is the sixth in a series of briefings exploring the ongoing Medi-Cal transformation to provide whole-person health care for all Californians that goes beyond the doctor’s office or hospital to meet all of their physical and mental health needs.
Anastasia Dodson, Deputy Director of the Office of Medicare Innovation and Integration at the Department of Health Care Services, emphasized the integrated benefits of California’s Medi-Cal and the federal Medicare programs. Dodson highlighted the comprehensive support available to low-income Californians through Medi-Cal, the state’s Medicaid program, which works in conjunction with Medicare to ensure that dual-eligible individuals receive affordable and accessible healthcare.
“Medi-Cal provides comprehensive care for low-income Californians,” Dodson stated. “Medicare, a federal program, offers health coverage to older adults and people with disabilities. In California, approximately 6.6 million people are enrolled in Medicare, and 1.6 million of them are also eligible for Medi-Cal.”
Dodson elaborated on the significant advantages for those enrolled in both programs, often referred to as “dual eligibles.” These individuals typically have complex health conditions that require coordinated care across physical, behavioral health, and social needs. “Having access to both programs greatly benefits these individuals by helping them afford their healthcare and access a wide range of benefits,” she explained.
A crucial aspect of the integration is the availability of Medi-Cal MediConnect plans, which coordinate benefits across both programs. These plans are available in 12 counties and are expected to be statewide by 2026. “These plans combine benefits into one plan, simplifying the process for our members,” Dodson noted.
The recent elimination of the asset limit for Medi-Cal, effective January 2024, was another significant change highlighted by Dodson. This policy shift means that assets such as money in a bank account or a second car no longer impact eligibility for Medi-Cal. Only income and household size are considered, making it easier for more Californians to qualify.
Dodson also addressed changes in the Medi-Cal State Recovery Program, which seeks repayment for certain benefits received by members after age 55. “State recovery is limited to specific benefits and only applies to assets that go through probate,” she clarified. “Most Medi-Cal members and their heirs will not owe anything.”
As California continues to enhance its healthcare delivery system, Dodson encouraged eligible residents to take full advantage of their Medi-Cal and Medicare benefits. “Our goal is to make healthcare more fair, efficient, and focused on members’ needs,” she concluded.
At the forefront of advocating for individuals with disabilities and older adults is Keith Miller, the Executive Director of Communities Actively Living Independent and Free (CALIF). Situated in Los Angeles, CALIF is one of 28 independent living centers in California, dedicated to enhancing the quality of life for people with disabilities.
“Recently, we entered into a contract with one of the HMOs under the CalAIM program,” Miller shared. “This initiative is designed to offer community support services for high utilizers and individuals frequently entering emergency rooms. Our services focus on housing retention, stabilization, and ongoing support, as well as case management services. These efforts are funded by Medi-Cal and reimbursed on a fee-for-service basis.”
The CalAIM program aims to connect people with disabilities to necessary services once they are discharged from hospitals, ensuring they receive continuous support. This pilot program utilizes Medi-Cal dollars to pay for direct services, supplementing them with additional services not covered by Medi-Cal.
“At CALIF, 51% of our staff are people with disabilities, and we offer a range of services, from benefits assistance and assistive technology to transitional services from nursing homes and youth transition support,” Miller explained. “We also provide peer counseling and advocate for systems change on federal, state, and local levels, including working on ADA compliance.”
Lily Sanchez, a program manager at CALIF, highlighted the profound impact of their services. She recounted a success story involving a client referred by Molina Healthcare. The client, at high risk of being institutionalized in a nursing home, received comprehensive support from CALIF. The team helped him obtain essential services, including in-home support, transportation, and proper identification. “Through our coordinated efforts with the HMO, we managed his social needs while they handled the medical aspects. Today, he is housed, receiving in-home support services, and no longer frequently uses emergency rooms,” Sanchez noted.
CALIF’s dedication to providing fundamental services, such as housing assistance, benefit acquisition, and emergency preparedness, underscores its commitment to fostering independence and improving the lives of people with disabilities.
“The only criteria to receive services at CALIF is being a person with a disability who can benefit from our support,” Miller emphasized. “Our foundation starts with core services, and it is crucial for those in need to connect with community-based organizations like ours to ensure they receive comprehensive care.”
