Key takeaways
Street medicine providers are establishing innovative partnerships with Medi-Cal managed care plans to create funding streams that support their mission of delivering health care to unhoused Californians where they live.
Yet there are gaps in the current contracting relationships between managed care plans and street medicine providers that are impeding providers’ financial sustainability.
The brief provides recommendations for both street medicine providers and managed care plans to achieve more effective contracting.
Street medicine has been a small but growing part of the California health care landscape since the early 1990s, with providers delivering health and social services to people experiencing unsheltered homelessness in their own environment, tailored to meet their needs and circumstances. Funding for street medicine has traditionally relied on grants, donations, and funding from parent organizations (e.g., hospitals and brick-and-mortar clinics). These funding sources are often cobbled together from year to year, leaving street medicine programs with a great deal of uncertainty.
California has implemented new programs — beginning in 2022 through the CalAIM (California Advancing and Innovating Medi-Cal) initiative — and has enacted policy changes that offer opportunities for street medicine providers to become part of the Medi-Cal managed care environment. Contracts with Medi-Cal managed care plans have the potential to provide more financial sustainability for providers.
This issue brief, Enhancing Financial Sustainability for Street Medicine: Examining Medi-Cal Managed Care Contracts with California Providers (PDF), provides a snapshot of contracting efforts between a sample of managed care plans and street medicine providers in the summer of 2024 and the impact that those contracts are having on the financial sustainability of street medicine providers. In addition, a statewide survey of street medicine providers was conducted in November and December 2024 to document the status of this type of contracting across the state. Both the brief and the survey were produced by researchers at California Health Policy Strategies.
Authors & Contributors
Gretchen Schroeder
California Health Policy Strategies
David Panush
David Panush, president of Sacramento-based California Health Policy Strategies, is working with the California Health Care Foundation to improve the linkage to health care for people returning to the community from jail and prison. Panush spent 35 years in state government, where he gained a unique understanding of policy, politics, state budget issues, and the inner workings of the legislative process. He was part of the core senior leadership team responsible for launching and managing Covered California, the state’s health benefit exchange.
Jane Ogle
California Health Policy Strategies
