California managed care plans are partnering with providers to improve access to assisted living, but advocates say that some challenges exist.
Under CalAIM (California Advancing and Innovating Medi-Cal), assisted living and adult residential care operators can tap into reimbursements from Medi-Cal, California’s Medicaid program, through the Enhanced Care Management benefits and optional Community Supports services through contracts with managed care plans.
Enhanced Care Management is a new Medi-Cal benefit available to beneficiaries who have complex health and social needs; it provides intensive coordination of health and health-related services to enrollees.
CalAIM’s Community Supports services are meant to help address health-related social needs while avoiding higher, costlier levels of care. Medi-Cal managed care plan enrollees living in a skilled nursing facility, or living at a traditional home in the greater community but at high risk of needing skilled nursing care, may be eligible to choose to live in a contracted assisted living community. The service, which reimburses operators for care and support, including personal care and medication management, is designed to prevent unnecessary institutionalization and promote person-centered living.
California Assisted Living Association President and CEO Sally Michael said that CalAIM provides new opportunities to serve older adults in the Medi-Cal program and the potential to provide better access to care across the continuum but that questions remain.
“CalAIM Community Supports and Enhanced Care Management services are still being developed, and there are a lot of unknowns,” Michael told McKnight’s Senior Living. “CALA is working to make sure current assisted living waiver providers can continue serving their residents under this new program and is focused on facilitating partnerships between managed care plans and interested providers.”
Michael said it is vital that stakeholders and active participants are fully engaged in the process as the state moves forward with the program.
Similarly, LeadingAge California said that it is a proponent of affordable assisted living options for all, although the association has some concerns.
“We are optimistic that essential assisted living services will soon be available to more older adults under ClAIM’s Community Supports for Nursing Home Diversion and Transitions and want to ensure that assisted living providers are given the tools and resources necessary for contracting with the managed care plans and operating within the new parameters of CalAIM,” LeadingAge California General Counsel and Chief Government Affairs Officer Meghan Rose told McKnight’s Senior Living. “We are concerned because we have seen a slow uptake of these community support by the managed care plans to date.”
Rose said that as the state moves to merge the assisted living waiver with CalAIM, LeadingAge California will be advocating for the expansion of assisted living services by all managed care plans across the state.
What to know
The potential benefits of a partnership include increased access to assisted living and adult residential programs for Medi-Cal members. The California Health Care Foundation, a nonprofit philanthropic organization, said that an estimated 9% of skilled nursing facility residents could be better served in less restrictive settings, such as assisted living and adult residential care communities.
According to California’s Department of Health Care Services, or DHCS, CalAIM’s Community Supports program showed that among nursing home residents who relocated to other settings, 25% to 35% transitioned to assisted living. The community transition service was associated with a decrease in 12-month readmission rates, from 17% to 12%, as well as a 20% increase in life satisfaction and savings of up to 50%, according to DHCS.
The CHCF further noted that partnering with plans could help operators boost occupancy levels in competitive markets and stabilize occupancy in older buildings, diversify an operator’s payer mix and strengthen its financial stability. Collaborating with community-based agencies to supplement residential services also could lead to better outcomes and increased resident retention, according to the foundation.
But the partnerships come with some challenges, including the need for operators to navigate increased oversight, the reporting and infrastructure requirements for managed care plans, as well as the stricter regulatory requirements related to resident assessments, care coordination and documentation, CHCF said.
The foundation recommended that operators and market teams clearly articulate care needs tied to the costs for providing care to residents who are managed care enrollees.
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