California reformed Medi-Cal to include ‘whole person care’ – does it work?

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UCLA researcher Nadereh Pourat, who led the pilot evaluation, said her team had just begun analyzing the impact on specific health conditions, such as blood pressure and congestive heart failure, as well as cost-effectiveness.

Despite their promise — or perhaps because of it — proponents say the transition from pilot programs to CalAIM will need to be watched carefully.

Responsibility has now shifted from county health departments to health care plans, which do not always meet quality criteria. And health plans in the 33 counties that had no pilots are starting from scratch.

“There are serious concerns about the ability of the Medi-Cal (health care) plans on the ground to implement some of the work necessary for CalAIM to be truly effective and live up to its potential,” said health policy expert Douglas.

“In some cases, plans are struggling to provide quality care through what we consider very basic measures: childhood vaccinations, are people getting mammograms on time, just very basic preventative care and chronic disease management.

Alameda County Admissions Specialist Annie Wyley meets with a Medi-Cal patient in the redesigned dining room at the Radisson Hotel in Oakland. (Martin do Nascimento/CalMatters)

Accountability is particularly important for improving equity among minorities, advocates say.

“Communities of color are disproportionately impacted by these same factors: lack of housing, lack of income, lack of food security,” said Cary Sanders, senior director of policy for the California Pan-Ethnic Health Network.

Health plans must provide “linguistically and culturally appropriate” services, Sanders said.

A critical component of the pilot programs that has been omitted from CalAIM is legal aid. In counties that funded legal aid during the pilot programs, lawyers and paralegals were stationed at medical clinics to help patients who needed help with benefit denials, eviction notices, immigration issues or domestic violence cases.

Often, patients and even their doctors don’t realize that their problem might require the help of an attorney, said Daniel Nesbit, attorney responsible for medical-legal partnerships with California Rural Legal Assistance. Nesbit said during the pilot program in Monterey County, his team helped 700 clients with more than 1,000 cases.

“A really good example is someone who is struggling with some kind of health issue, and it’s hard for them to go to work every day and do their job fully,” Nesbit said. “They might not know, for example, that they have a possible right to reasonable accommodation under the Americans with Disabilities Act.”

Alameda and Contra Costa counties, which contracted with Bay Area Legal Aid to participate in the pilot, have hired five additional attorneys dedicated to assisting Medi-Cal patients. The partnership made it possible to reach people who would not normally have access to legal aid because their disability prevented them from coming to an appointment or because they did not have a telephone number or ‘address. Case managers were able to put people in touch with lawyers, which amounts to 300 referrals a year.

But when the pilot ended in December and state funding dried up, the attorneys were reassigned and no longer able to focus on Medi-Cal patients.

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