Medi-Cal Program Lacks Coordination

A new report from a public interest research firm concludes that despite large safety net insurance expansions in California as a result of the Affordable Care Act, the provider system remains too patchwork and chaotic to provide appropriate care for the state's poorest and neediest residents.

The report, authored by San Francisco-based John Snow, Inc. and underwritten by the Blue Shield of California Foundation, suggests the state needs to focus on what it calls “whole-person care” - an integration of health and social services that would improve outcomes and cut costs for providing services.

While the recent expansion of Medi-Cal coverage both based on income and for mental health and substance abuse treatment provides a great opportunity for California to better care for these populations – some $8.9 billion in additional funding is flowing into the state this fiscal year as a result – many counties and local jurisdictions have failed to properly align services. “We heard multiple stakeholders recount that 'co-location does not equal coordination,'” said the report, which interviewed officials from healthcare and social service agencies from five Northern and Southern California counties.

The most vulnerable populations as identified by the report are the homeless, juveniles in the state justice system and adult prisoners. Nearly half of California's homeless have a mental illness or substance abuse issue; 70% of juvenile offenders have one mental health issue, and 20% of adult prisoners have had a recent history of mental illness or conditions.

Although the report noted that some jurisdictions, such as Los Angeles County, have made it a priority to identify and target mentally homeless populations that consume a large amount of healthcare services, only a handful of local programs are well-integrated.

Among the report's recommendations:

• Counties should appoint a dedicated care coordinator “both in the form of a lead responsible agency and an individual, culturally competent, linguistically appropriate coordinator,” to ensure care is delivered to vulnerable populations more appropriately.

• Designated medical homes for Medi-Cal enrollees must address medical and non-medical needs, including services that could help alleviate homelessness
• Medi-Cal managed care plans could eventually be charged with coordinating healthcare and mental health services
• Data infrastructure should be in place for agencies, providers, health plans and other stakeholders to more easily share data, possibly in the form of small, regional health information exchanges (HIEs)
• More flexibility should be given to Medi-Cal managed care plans for capitation rate setting to include non-medical services 

“Medi-Cal expansion and other health policy changes have galvanized local and state leaders to rethink how traditionally fragmented systems can work together in new ways on behalf of California's low-income and vulnerable populations,” said Rachel Tobey, Director of John Snow's San Francisco office and lead author on the report.