CenCal Health to manage State’s transformation of Medi-Cal on the Central Coast
The California Advancing and Innovating Medi-Cal program – known as CalAIM – is the far-reaching, multi-year plan to transform Medi-Cal. The long-term mission of CalAIM is to offer 14+ million Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory. The comprehensive program was developed by the State of California’s Department of Health Care Services (DHCS). In Santa Barbara and San Luis Obispo counties, the local health plan CenCal Health is responsible for managing the implementation of CalAIM with its community partners.
CalAIM will provide expanded services that go beyond traditional medical care, addressing social factors that affect human health from birth to end of life, including homelessness, behavioral health, care of older adults, services for individuals transitioning from incarceration, and beyond. CalAIM is the State’s largest overhaul of how Medi-Cal services are delivered and paid since the implementation of managed care in the late 1970’s.
“Our community partners have continuously been at the forefront of innovation, providing person-centered care to our members and underserved neighbors,” said CenCal Health CEO Marina Owen. “With the opportunities afforded by CalAIM, we are pleased to support our providers’ efforts to enhance, expand, and strengthen local services.”
CenCal Health has implemented two new initiatives under the CalAIM framework. They are:
- Enhanced Care Management (ECM) is a benefit for members with complex needs requiring seamless coordination between multiple doctors and other care providers. With ECM, enrolled members are assigned a lead care manager who helps coordinate doctors, specialists, pharmacists, case managers, and social service providers, among others, in order to comprehensively manage the member’s primary care, acute care, behavioral health, developmental health, oral health, and community services and supports.
- Community Supports provides medically appropriate and cost-effective alternatives to traditional medical services. Community Supports comprehensively addresses the needs of members — including those with the most complex challenges affecting health such as homelessness, unstable and unsafe housing, food insecurity, and/or other social needs.
CenCal Health currently offers two Community Supports: Medically-Tailored Meals and Recuperative Care. Medically Tailored Meals provides meals to members with diabetes, congestive heart failure, or chronic kidney disease, and who have had a skilled nursing facility stay, inpatient hospital visit, or two emergency room visits within 12 months.
Recuperative Care is medically-supervised respite care for patients who have just been released from the hospital due to serious illness or injury, and are experiencing homelessness or at risk of homelessness. Community partners, shelters and local hospital providers Dignity Health, Cottage Health and Tenet Health have been offering recuperative care since 2019. Through CalAIM, CenCal Health will continue to support these critical services.
“Working together we can disrupt the cycle of preventable re-hospitalizations for those in our community experiencing homelessness,” said Marian Regional Medical Center President and CEO Sue Andersen. “It is great news that CalAIM and CenCal Health have made Recuperative Care an immediate priority in our county.”
Good Samaritan Shelter, PATH Santa Barbara, and Community Action Partnership of San Luis Obispo partner with the area hospitals to ensure an integrated referral and care coordination structure for members moving in and out of respite services. “Our shelter is committed to providing emergency, transitional and affordable housing with support services to the homeless and those in recovery throughout the Central Coast,” said Sylvia Barnard, Good Samaritan Shelter Executive Director.
More information about CalAIM on the Central Coast is available at cencalhealth.org/members/calaim/. Additional information about CalAIM can be found on the DHCS site at dhcs.ca.gov/calaim. To learn more about CenCal Health go to cencalhealth.org.
About CenCal Health
CenCal Health is a community-accountable health plan that partners with over 1,500 local physicians, hospitals and other providers in delivering patient care to nearly 220,000 members – about one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County. A public agency, the health plan contributes approximately $50 million a month into the local economy, primarily through payments to healthcare providers who serve its membership. Established in 1983, it is the oldest Medicaid managed care plan of its kind in the nation. View its annual Community Report at cencal2021.org.
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Media Contact: Sheri Mobley (805) 845-5627, 213 509-9816 email@example.com
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