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CalAIM Community Supports Sees Slow Initial Roll Out

California is making progress six months in, but there is still work to be done to reach goals and achieve health equity


August 17, 2022 California Advancing and Innovating Medi-Cal (CalAIM) was launched throughout the state on January 1, 2022. It is California’s transformation of Medi-Cal to a population health approach that prioritizes prevention and the incorporation of social determinants of health (SDoH) into care plans. 

As we discussed in a prior blog on the subject, CalAIM uses shared risk/savings and incentive payments to provide financial protection while also encouraging investments. There are several unique aspects of CalAIM, including the launch of Enhanced Care Management and Community Supports

Throughout this blog, we will take a look at how Community Supports have rolled out thus far in California and the importance of health equity across the state.  

What Are CalAIM Community Supports?

Community Supports, also known as In Lieu of Services (ILoS) are designed to address social determinants of health (SDoH). They are statewide services provided through managed care plans (MCPs) that are cost-effective alternatives to transition medical services. 

The idea of Community Supports or ILoS is not new. In fact, they are already incorporated in Whole Person Care Pilots, HCBS waivers, and the Health Homes Program. What is unique about CalAIM Community Supports is that the administration of these services and addressing complex social needs is being tied to managed care plans. 

All of the managed care plans in the state are encouraged to offer as many of the 14 Community Supports shown above as possible to address Medi-Cal enrollees’ health-related social needs like housing security and food. Through this, California strives to provide the wraparound whole-person care that individuals deserve. 

CalAIM Community Supports Rolling Out Slowly for Rural and Low-Income Counties

So, how have the CalAIM Community Supports fared in the last 6 months? The answer is that it depends on the location. Community Supports are option services and plans have made different decisions locally, which has led to variation across the state. 

11 counties in California did not even have county-wide Community Supports go live until July 1, 2022. This might not seem like a lot when you consider that California has almost 60 counties, but of those 11 counties, 5 have over 20% of citizens living in poverty. These are the people that often need medical and non-medical services the most and due to the phased roll out, were unable to access the services that they need.

In addition, 9 of the 11 counties where no Community Supports were rolled out initially are classified as Rural or Semi-Rural areas. According to the CDC, 15% of all Americans live in rural areas and are at a greater risk of death from 5 leasing causes (heart disease, cancer, unintentional injury, stroke, and chronic lower respiratory disease. Children in rural areas also face challenges with findings showing that kids with mental, behavioral, and developmental disorders face more family and community challenges. 

With a shortage of doctors and quality healthcare settings, rural communities need Community Supports the most to ensure optimal health outcomes. While we know the cause behind the lack of services is that many of these counties do not have Community Supports providers already in place, it is essential that they are not overlooked for implementation just because the process is more difficult. To achieve health equity, all counties across California—rural, urban, and in between—need to have the same access to great care.  

Counties With Community Supports Not Offering Many Services

In the counties where Community Supports went live on January 1, 2022, we also saw a wide range in the number that were launched.  Two counties, San Diego and Sacramento, had all 14 pre-approved Community Supports launch county-wide on January 1, 2022. 

However, the other counties in the State with Jan 1, 2022 go-live dates launched a range of 1 of the pre-approved Community Supports to 12. Most counties fell in the mid to high single digits. When there are 14 Community Supports, these numbers are not good enough.

While there are complexities in rolling out Community Supports, the range of services offered means that people throughout California are not getting equal access to care. These are services that allow individuals to heal, live, and age comfortably in their own homes. Not only is this important for the aging community, but it is also essential for the I/DD community to keep them remaining active members of the community. 

CalAIM Community Supports Roll-Out Plan Missing the Mark on Services Provided

There has also been a range of Community Supports offered in the initial rollout. As the chart below shows, the most commonly offered Community Supports as of January 1, 2022, included Meals/Medically Tailored Meals or Medically Supportive Foods, Asthma Remediation, Housing Transition Navigation Services, and Housing Tenancy and Sustaining Services.

While many Community Supports are offered by at least half of the plan/county pairs, others like Personal Care and Homemaker Services, and Community Transition Services are only offered by 10% and 9%, respectively. This disparity is alarming as home care services allow the aging and I/DD population to remain comfortably at home. While that number is expected to increase to 84% by 2024, the slow ramp-up will leave consumers without the whole-person care that they deserve and can negatively impact health outcomes.

While there is much progress to be made, the key takeaway here is that while the CalAIM program is still new, MCPs are taking the steps to implement Community Supports across the state. There is limited access to these services now, but as the chart above shows, by 2024 the majority of MCPs are going to be providing Community Supports across the state. It will be important in the coming months and years to ensure that consumers have access to both the medical and non-medical services that they need to achieve their optimal health outcome and live comfortably at home. It is a big ask for the state of California, but in our next blog we will look at how the state can achieve it’s goals. 

Advocates Perspective

With just over 7 months since its launch, CalAIM Community Supports are still new in California. It is slightly disappointing to see the disparity of services provided across counties, especially when some with limited to no services are the poorest and most rural in the state. These individuals already face more challenges when accessing quality care and it is essential that they get access to whole-person care to ensure health equity. However, there are some tradeoffs to consider. While expanding access to all of the Community Supports across California is important, the method by which services are rolled out is also crucial. If the implementation is rushed, there is a risk that it will become too complex of a system that is difficult for members and providers to navigate. In our next blog, we will take a look at lessons learned and best practices for the continued implementation of Community Supports.


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About the Author

Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).

His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.

mandy sahhar

About the Co-Author

Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.