Older adults with low incomes and people with disabilities are more likely to have multiple co-occurring health conditions and a range of social needs. This complexity means that fragmentation of care and services is particularly harmful for this group. For this reason, the California Department of Health and Human Services has prioritized the 2.2 million seniors and people with disabilities enrolled in Medi-Cal as one of several populations of focus under CalAIM.
More than 1.6 million of these Californians are dually eligible for Medi-Cal and Medicare, creating additional important needs for integrating care and support across different programs, payers, and provider networks. Medicare, for example, plays a significant role in paying for health care services for dually eligible enrollees. Meanwhile, Medi-Cal covers important services like long-term nursing home care and personal care services, often doing so outside of managed care. CalAIM’s goals include making it easier for these individuals to stay in their homes and communities rather than move to nursing homes and improving coordination of their medical and nonmedical care.