Brittney Daniel, Program Officer – Health, California Community Foundation
Laura Hogan, Senior Health Care Consultant, Pacific Health Consulting Group
Erin Jackson-Ward, Director of Community Benefit Giving, Cedars-Sinai
Alissa Ko, Senior Director of Public Affairs, Health Net
Dorothy M. Seleski, Vice President, Network, Access and Partnerships, Health Net
Rosemary C. Veniegas, Senior Program Officer – Health, California Community Foundation
Each night in Los Angeles County there are 63,706 people sleeping in building entryways, under bridges, in their cars, or simply in the open (Los Angeles Homeless Services Authority 2020). Many have chronic health conditions including diabetes, heart disease, untreated symptoms of mental illness, or chemical dependency. All need a safe and stable place to live and ongoing access to health care. California has a new plan under its recently-approved Medicaid waiver that builds on innovations implemented in recent state programs and is centered on health equity, especially for people experiencing homelessness.
Medicaid, the federal health care program that provides health coverage to income-eligible residents, distributes funds to states with certain requirements. California and other states often request waivers for some of these requirements to pilot new strategies for health care delivery and payment to further the program’s goals.
California’s next Medicaid waiver, known as California Advancing and Innovating Medi-Cal (CalAIM), officially launched in January 2022. (Medi-Cal is the state’s name for California’s Medicaid program.) The three primary goals of CalAIM include:
- applying whole person care approaches to address social determinants of health while managing beneficiaries’ risk;
- reducing complexity and increasing flexibility to implement a consistent and seamless system; and
- conducting value-based initiatives, system modernization, and payment reform with the intent of improving outcomes and driving delivery system transformation.
Using Medi-Cal funding to address linked housing and health issues is a major step in creating equitable care. Proposed innovations in CalAIM include reimbursement of housing transition and management services, housing deposits, recuperative care/medical respite, medically tailored meals, sobering centers, and asthma remediation (Medicaid and CHIP Payment and Access Commission 2021). California is one of four early adopter states to providing these housing transition and tenancy supports under its Medicaid waiver (Thompson, Farnham, Tiderington, Gusmano, and Cantor 2021). If successful, CalAIM will offer an implementation model for health equity embedded in a federal and state funded program.
Well before the introduction of CalAIM, our three organizations were committed to addressing the needs of Medi-Cal beneficiaries, including people experiencing homelessness. Each of our teams has a funding strategy or emphasis on topics including behavioral health integration, care for communities with chronic health conditions, and addressing homelessness as a social determinant of health. Our partnership on CalAIM emerged from shared experiences in the community health improvement and community benefit spaces, which most recently included deepening telehealth funding, expanding work with local safety-net partners, and establishing collective partnerships to maximize expedience and access for mass COVID-19 vaccinations.
The California Community Foundation (CCF) leads systemic change that strengthens L.A. County. CCF’s funding priority areas include health, housing, immigration, and education. CCF is currently funding capacity building for and advocacy efforts of Medi-Cal providers delivering substance use disorder treatment services as well as housing for people with mental health conditions.
Cedars-Sinai is a nonprofit health system serving Los Angeles County, CA, with an institutional mission that has long encompassed improving the health of the community through both the provision of patient care and support of community partners. Cedars-Sinai partners with government, philanthropic, and health department entities to build nonprofit capacity, elevate community clinic leadership, enhance behavioral health integration, advance economic stability, and support coordination among health, social services, and housing settings.
Health Net is the state’s largest commercial Medi-Cal plan, serving more than 2 million members statewide. Founded more than 40 years ago in California, Health Net is one of the state’s most experienced Medi-Cal partners and has worked together with the state to build Medi-Cal and serve those who depend on its health care safety net. Today, two-thirds of Health Net’s members are Medi-Cal enrollees: low-income adults, seniors, pregnant women and children, foster children, undocumented residents, and persons with disabilities.
Our complementary efforts during the COVID-19 rapid response phase in 2020 foreshadowed our work together on Medi-Cal. We coordinated with other health funders to support increased access to health care for people experiencing homelessness, which included support for on-site access at shelters and temporary housing sites opened during the pandemic. All three of our organizations funded related elements of the rapid shift to telehealth in 2020, from hardware to operations adaptation. Twenty months later, the telehealth work continues through interrelated efforts by CCF to create advocacy for steady and high-quality internet in communities disproportionately affected by COVID-19 and grants by Cedars-Sinai and Health Net focused on innovating and spreading telehealth solutions. We see a similar opportunity with the CalAIM waiver to leverage our aims and assets for nonprofits serving people experiencing homelessness.
During the first quarter of 2022, our three organizations awarded $1.2 million in grants to 10 nonprofits that will be assessing their readiness to engage as CalAIM providers to ultimately deepen their partnerships with existing homelessness services providers. Potential recipients were identified by compiling a list of more than 70 nonprofits that had participated in previous Medi-Cal waivers serving people experiencing homelessness, provided services at temporary shelters, or that were co-located with federally qualified health centers. Over the next two years, we will work with these nonprofits to fund readiness assessments, capacity building, and business model evolution if they pursue Medi-Cal provider status under CalAIM.
As the COVID-19 pandemic continues, we believe that addressing housing and health jointly is a key health equity endeavor. We see the pandemic, health conditions rooted in structural inequality, and the experience of homelessness as intertwined crises calling for collective action. Building on the emergent and ongoing partnerships among our organizations allows us to pursue our respective missions while advancing health equity. We welcome the opportunity to share promising practices and lessons learned with other health funders who are working on these issues.
References
Los Angeles Homeless Services Authority. “2020 Los Angeles Greater Homeless Counts Results.” June 12, 2020. Accessed November 2, 2021.
Medicaid and CHIP Payment and Access Commission. “Medicaid’s Role in Housing,” June 2021. Accessed November 23, 2021.