Many aging adults and people with disabilities need support and assistance throughout their lifetimes. In California, Medi-Cal is an important source of funding for home and community-based services (HCBS) that help people live independently, such as personal care, adult day health services, case management, and home-delivered meals.

Yet qualifying for Medi-Cal doesn’t guarantee access to these services, and access to and types of supportive services vary across the state. While California has prioritized HCBS through a variety of programs, limited data collection, evaluation, and reporting make it difficult to assess inequities in how and to whom these services are being provided.

With support from CHCF, Justice in Aging is producing a series of issue briefs focused on helping state agencies, policymakers, and other stakeholders support equitable HCBS rather than institutional care where possible and desirable.

The first paper in the series, Beyond Spending: Measuring California’s Progress Toward Equitable HCBS, describes how measures that examine “rebalancing” – or the balance between HCBS versus care in institutions –can advance equitable long-term care for Medi-Cal enrollees; the effects of managed care on the ability to track expenditures for long-term services and supports; why expenditure data alone are insufficient to measure progress in rebalancing; and measurement approaches that would advance California’s goal to build a more equitable, balanced long-term care system.

The second paper, Equity Framework for Evaluating California’s Medi-Cal Home and Community-Based Services for Older Adults and People with Disabilities, examines five domains of HCBS programs where inequities can arise; provides examples of how and where these types of inequities can show up; and describes policies, program rules, program features, and implementation decision points where aspects of equity should be examined and evaluated.

The third paper, California’s Assisted Living Waiver: An Equity Analysis, uses the equity framework described above to examine California’s Assisted Living Waiver (ALW). The ALW provides personal and health-related services to eligible Medi-Cal enrollees in residential care facilities or publicly subsidized housing as an alternative to long-term placement in a nursing facility. The paper and an accompanying webinar summarize the ways inequities can arise within the ALW, and provide recommendations for addressing these inequities.

The fourth (and final) paper, California’s In-Home Supportive Services Program: An Equity Analysis, uses the equity framework to examine the In-Home Supportive Services (IHSS) program, which provides consumer-driven personal care services and other supports to Medi-Cal enrollees to enable them to remain in their own homes, rather than living in a nursing home or other facility. The paper and an accompanying webinar examine how five domains of the IHSS program can impact equitable access and outcomes, and provides examples of policies, rules, and decision points that can address inequities.