Using Data for Good: Toward More Equitable Home and Community-Based Services in Medi-Cal

Amber Christ, Directing Attorney, Justice in Aging
Tiffany Huyenh-Cho, Senior Staff Attorney, Justice in Aging


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Most aging adults and people with disabilities will require some kind of assistance to remain living in their homes and communities over their lifetime. In California, Medi-Cal is the primary payer of at-home care known as home and community-based services (HCBS) that allow aging adults and people with disabilities to get the help they need at home or in community-based settings as an alternative to receiving care in a nursing facility.

From help with bathing and dressing, to community-based day centers that provide support and activities, to intense case management, California offers a multitude of HCBS programs to people with low incomes who rely on Medi-Cal for health coverage. Yet despite the wide array of HCBS in California and the significant Medi-Cal funding for these services, there are few public data to demonstrate whether HCBS is equitably available and used by those who qualify for services.

For Medi-Cal enrollees, access to these types of supportive services varies across the state. The limitations of public data hinder understanding of who is receiving which services and where, and what inequities may exist by race, age, geography, type of disability, and other factors. This paper, which focuses specifically on Medi-Cal HCBS and Medi-Cal-funded long-term care, aims to support state staff, policymakers, and other HCBS stakeholders in ensuring the robust collection and reporting of HCBS data as the state undertakes various efforts to improve these services. It includes a summary of the complexities and challenges of the current HCBS infrastructure for data collection, including an overview of the existing gaps in HCBS data, recommendations to address those challenges and gaps, and strategies for moving the recommendations forward.

Learn more about what data are publicly available for HCBS through the table below.

Table. A Summary of Publicly Reported Data, by HCBS/Long-Term Care Program, 2021

Legend:  ██ Publicly reported     ██ Not publicly reported

IHSS ALW AIDS HCBA HCBS-DD CBAS MSSP CCT CMC MLTSS PACE NF ICF-DD
Demographics
Age *
Disability
Race/Ethnicity *
Gender *
Language Spoken
SOGI
Location
Program Access
Total Participants
Waitlist Number N/A N/A N/A N/A N/A N/A N/A N/A N/A
Facility/Center/Site N/A N/A N/A N/A N/A N/A N/A
Beds N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
Hours Authorized N/A N/A N/A N/A N/A N/A N/A N/A N/A
Transitions N/A N/A N/A N/A N/A N/A N/A
Diversions N/A N/A N/A N/A N/A N/A N/A N/A N/A
HCBS-Like Services N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

* These MSSP data were available in 2019 but not 2020 or 2021.

Note: AIDS is Acquired Immunodeficiency Syndrome waiver; ALW is Assisted Living Waiver; CBAS is Community-Based Adult Services (formerly known as Adult Day Health Care) waiver; CCT is California Community Transitions; CMC is Cal MediConnect health plan; HCBA is Home and Community-Based Alternatives waiver; HCBS-DD is Home and Community-Based Services for the Developmentally Disabled waiver; ICF-DD is Intermediate Care Facility for the Developmentally Disabled; IHSS is In-Home Supportive Services; MLTSS is Managed Long-Term Services and Supports; MSSP is Multipurpose Senior Services Program waiver; N/A means it’s not a relevant data point for that program; NF is nursing facility; PACE is Program of All-Inclusive Care for the Elderly; SOGI is sexual orientation and gender identity.