Creating Robust Provider Networks to Support Older Adults and People with Disabilities

Elderly woman at home receiving medical care
Seniors and people with disabilities who need help and support with daily tasks can face challenges having their health and social needs met. Photo: Andrew Lichtenstein / Corbis via Getty Images

Medicaid agencies across the country are engaging in innovative initiatives to address both the health and social needs of older adults and people with disabilities. Many of these initiatives involve either expanding existing provider networks or developing new provider networks in sectors such as social services, care management, institutional care, and Medicare. In California, Medi-Cal, the state’s Medicaid agency, is undertaking an ambitious statewide initiative known as California Advancing and Innovating Medi-Cal (CalAIM) to transform services for people with the greatest needs and costs. As part of this initiative, Medi-Cal managed care plans in California are expanding health and social service provider networks to better respond to the needs of older adults and people with disabilities.

Under CalAIM, managed care plans are contracting with community-based social service providers and care management organizations to offer nonmedical Community Supports and Enhanced Care Management services for people with the most complex care needs. Managed care plans in California are also strengthening their networks of institutional long-term care providers — including skilled nursing, subacute, and intermediate care providers — as they carve in long-term care. Additionally, many plans that serve people who are dually eligible for Medicaid and Medicare will be building networks of Medicare providers as they create aligned Dual Eligible Special Needs Plans, called Medicare Medi-Cal Plans.

This blog post, made possible by the California Health Care Foundation, reviews considerations for California and managed care plans as they fortify provider networks to ensure that older adults and people with disabilities have their health and social needs met. It focuses on strategies for partnering with three key provider types: (1) community-based organizations, (2) institutional long-term care facilities, and (3) Medicare providers. Lessons from managed care plans in California are highlighted throughout and can inform managed care organizations in other states.

Read the full post at the Center for Health Care Strategies.

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