Understanding What Works: Measuring and Monitoring Quality in Medi-Cal’s Home and Community-Based Services

By 2030, more than one million Californians will need assistance with activities of daily living and will need to rely on systems that provide “long-term services and supports” for help with tasks such as taking medications, preparing meals, and getting dressed. Most older adults and people with disabilities prefer to receive this type of care in their own homes and communities.

Home and community-based services (HCBS) allow older adults and people with physical and/or cognitive disabilities, serious mental illness, and disabling chronic conditions to live safely and independently, rather than moving to institutional settings such as nursing facilities.

California’s Medicaid program, the largest in the country in terms of expenditures and enrollees, spends an estimated $22 billion per year to provide HCBS. As California experiences rapid population aging, the need for these services will increase. However, few data currently exists to monitor the quality and outcomes of HCBS, essential to ensuring timely and reliable access to high-quality services.

Over the next several years, California’s Medi-Cal managed care plans are poised to take on greater roles in overseeing existing and new forms of Medi-Cal HCBS under the CalAIM (California Advancing and Innovating Medi-Cal) initiative. Shared interest among HCBS stakeholders in ensuring high-quality care underscores the importance of a robust approach to quality monitoring for these services.

This issue brief describes challenges and opportunities related to measuring, reporting, and monitoring the quality of HCBS sponsored by Medi-Cal, including data issues, preconditions to ensure readiness and successful implementation of quality monitoring, considerations of equity, and examples of HCBS quality measurement efforts in other states that may inform efforts in California.