Publications / Advancing Equity in Medi-Cal’s Home and Community-Based Services

Advancing Equity in Medi-Cal’s Home and Community-Based Services

Justice in Aging

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 in efforts to 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.

Additional papers in this series will be released in coming months.