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Understanding what works: measuring and monitoring quality in Medi-Cal’s home and community-based services
Understanding what works: measuring and monitoring quality in Medi-Cal’s home and community-based services
- Collection:
- Health Policy and Services Research
- Author(s):
- Harrison, Jordan, (Of RAND Corporation), author
Shih, Regina A., author
Ahluwalia, Sangeeta C., author - Contributor(s):
- California HealthCare Foundation, issuing body.
Rand Corporation, issuing body. - Publication:
- [Oakland, CA] : California Health Care Foundation, January 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Community Health Services
Home Care Services
Medicaid
Quality of Health Care
California - Genre(s):
- Technical Report
- Abstract:
- By the year 2030, over one million Californians will need assistance with the activities of daily living and will need to rely on systems that provide “long-term services and supports” for help with tasks such as taking medications, preparing meals, and getting dressed. Most older adults and people with disabilities prefer to receive this type of care in their own homes and communities. Home and community-based services (HCBS) allow people with functional limitations to have those preferences honored--to live safely and independently, rather than moving to institutional settings such as nursing facilities. California’s Medi-Cal program--the largest Medicaid program in the country in terms of expenditures and enrollees--spends an estimated $22 billion per year to provide essential HCBS to older adults and people with physical or cognitive disabilities, serious mental illness, and disabling chronic conditions. As California experiences rapid population aging, the need for these services will increase. However, few data are currently collected to monitor the quality and outcomes of HCBS, which is essential to ensuring timely and reliable access to high-quality services. HCBS, combined with institutional long-term care, are collectively referred to as long-term services and supports (LTSS). California’s Department of Health Care Services (DHCS) oversees Medi-Cal LTSS, although LTSS benefits are administered by multiple departments across the California Health and Human Services Agency. Some HCBS (e.g., In-Home Supportive Services, home health services) are available to all qualifying Medi-Cal enrollees through California’s Medicaid State Plan, while other services are available to specific types of Medi-Cal enrollees through waivers to the State Plan. These waivers allow states to offer services not otherwise available through Medicaid. CalAIM (California Advancing and Innovating Medi-Cal) is a multiyear initiative introduced by DHCS to improve the quality of life and health outcomes across the Medi-Cal program. With implementation of CalAIM’s delivery system, program, and payment reforms, evidence-based approaches for systematic measurement of HCBS quality will become increasingly important to health plans responsible for managing these services, and to state stakeholders monitoring the impact of this transition. Under the proposed reforms, Medi-Cal will shift the balance from fee-for-service delivery of LTSS to Managed LTSS (MLTSS) models in which managed care plans deliver some LTSS to Medi-Cal enrollees state-wide by 2027. Other core components of CalAIM, Enhanced Care Management and Community Supports (In Lieu of Services), provide HCBS-like services aimed at supporting Medi-Cal enrollees with complex needs; implementation began in January 2022. Across these reforms, the increasing role of Medi-Cal managed care plans (MCPs) in overseeing existing and new forms of Medi-Cal HCBS and the shared interest among state stakeholders and MCPs in ensuring high-quality care underscore the importance of a robust approach to quality monitoring for these services. Challenges currently facing California’s HCBS system include waiting lists for some programs, gaps and inequities in access to HCBS, regional variation in availability of home and community-based options to meet consumer needs, direct care workforce shortages, and budget constraints that limit capacity for investment in quality improvement efforts. Understanding these challenges, California is investing in its HCBS future through several efforts including California’s Master Plan for Aging. This 10-year blueprint outlines strategies to attain a series of ambitious goals to improve aging across the lifespan for Californians, including substantial investments in HCBS infrastructure and LTSS delivery system innovation. These goals were reflected in California’s $4.6 billion HCBS Spending Plan stemming from the federal American Rescue Plan Act of 2021. The plan provides essential funding for long-term investment in HCBS infrastructure. In addition, California has received federal approval for funding to develop an HCBS Gap Analysis and Roadmap, providing a critical pathway to evaluate current capabilities and gaps in California’s approach to quality monitoring in HCBS and to identify opportunities for improvement. These proposed examinations of and changes to California’s HCBS system bring opportunities to improve measurement of HCBS quality for Medi-Cal’s seniors and people with disabilities, including those enrolled in Medi-Cal only and those enrolled in both Medi-Cal and Medicare (dually eligible enrollees). This report describes challenges and opportunities related to measuring, reporting, and monitoring the quality of HCBS sponsored by Medi-Cal, including data issues, preconditions to ensure readiness and successful implementation of quality monitoring, considerations of equity, and examples of HCBS quality measurement efforts in other states that may inform efforts in California. Though many different public and private agencies and organizations provide a variety of HCBS in California, the focus of this report is HCBS paid for by Medi-Cal.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (22 pages))
- NLM Unique ID:
- 9918573684106676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918573684106676