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The California Department of Health Care Services (DHCS) has piloted several initiatives to better coordinate care for the approximately 360,000 seniors and persons with disabilities (SPD) in Medi-Cal’s fee-for-service program.  These initiatives have included:

  • two disease management pilot projects;
  • two coordinated care management pilots targeting those with multiple chronic conditions and those with severe mental illness; and
  • a Medical Case Management program, under which approximately 2,000 beneficiaries per month receive the services of a state nurse care manager who assists in assuring care coordination and continuity (among other roles).

DHCS is looking to build on these initiatives to offer a medical home to all SPD Medi-Cal beneficiaries.  As per the Center for Health Care Strategies report referenced below, DHCS has defined its policy aims as follows:

  1. "Provide a medical home for each of the approximate 360,000 FFS SPD, i.e., establish a mandatory relationship with a patient-centered provider of primary care services;
  2. Identify, assess, and stratify the needs of the target population;
  3. Tailor care interventions to meet the needs of subsets of the target population, including those experiencing disparities in care associated with race, ethnicity, language, and literacy;
  4. Address the psychosocial, preventive care, and social support needs of high-risk beneficiaries through effective care coordination and management interventions, and linkages to appropriate community-based services;
  5. Use innovative HIT solutions to share data with providers on their panel of patients, practice performance, and their compliance with evidence-based guidelines;
  6. Measure performance to promote accountability and quality improvement; and
  7. Structure financing to support the EMH [enhanced medical home] program’s ability to perform the above functions.”

As of March 2010, California is preparing to submit a 1115 waiver renewal application to CMS in August 2010.  DHCS is currently considering how to best prepare its 1115 waiver renewal request as to further these medical home goals, while prospectively assuring cost-neutrality over the next five years.

Targeted population: 360,000 seniors and persons with disabilities (SPD) in Medi-Cal’s fee-for-service program.

For more information, please see the Center for Health Care Strategies’ September 2009 report Enhanced Medical Home For Medi-Cal’s SPD Population:
http://www.dhcs.ca.gov/provgovpart/Documents/Enhanced%20Medical%20Home%20(CHCS-posted).pdf