CalAIM (California Advancing and Innovating Medi-Cal) is a comprehensive, multiyear effort led by the California Department of Health Care Services that seeks to implement broad delivery system, program, and payment reform across California’s Medi-Cal program.

Like many states, California uses managed care delivery systems to administer Medi-Cal. Currently, more than 8 in 10 Medi-Cal enrollees are in Medi-Cal managed care plans (MCPs), a number that will increase as CalAIM further expands mandatory managed care enrollment. One CalAIM reform initiative, the “institutional long-term care carve-in,” will require that care in nursing homes and other institutional settings be provided as a benefit through Medi-Cal MCPs statewide as of January 1, 2023.

This report describes the challenges, opportunities, and lessons learned from select California counties and other states where institutional long-term care has already been administered by MCPs. It focuses on the experiences of seniors and adults with disabilities, including those with Medi-Cal only and those with both Medi-Cal and Medicare (dually eligible enrollees), and describes opportunities to design a system that achieves the following:

• Improves access to appropriate institutional care for those who need it
• Promotes care in home and community-based settings and diverts care away from institutions when possible and desired by the person receiving care
• Promotes higher quality of care in institutional settings
• Addresses equity in California’s long-term care services

This report is intended to inform state officials, MCP leaders, institutional long-term care providers, community providers serving those with long-term care needs, and advocates, who will all play unique roles as this policy moves forward.

About the Authors

Carrie Graham, PhD, is the director of long-term services and supports at the Center for Health Care Strategies, a policy design and implementation partner devoted to improving outcomes for people enrolled in Medicaid, including those dually eligible for Medicare and Medicaid.

Hope Glassberg, MPA, is the president of Decipher Health Strategies, a firm providing experience at the intersection of health policy, strategy, and operations to states, nonprofits, and technology organizations.

Athena Chapman, MPP, is president; Elizabeth Evenson is senior policy director; and Samantha Pellón, MPH, is policy director at Chapman Consulting, which provides strategic planning, meeting facilitation, organizational support, market research, and regulatory and statutory analysis to organizations in the health care field.

Webinar

Authors of this report and another CHCF report, CalAIM Community Supports: Promoting Independent Living Among Older Adults and People with Disabilities, jointly presented key findings about the opportunities for both Community Supports and Medi-Cal’s institutional long-term care carve-in to promote community living on a webinar on May 19, 2022. The webinar recording and slides are available here.