Beyond Spending: Measuring California’s Progress Toward Equitable HCBS


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, because the federal government doesn’t require states to pay for HCBS, resulting in uneven access across the state. While California has prioritized HCBS through a variety of programs, limited data collection, evaluation, and reporting make it difficult to assess how well the state is balancing HCBS versus care in institutional settings (often called “rebalancing”).

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 describes how rebalancing measures 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.