Utilizing Medicaid Demonstration Waivers to Help Address Soc…

In December of 2021, the California Department of Health Care Services (DHCS) received CMS approval for the CalAIM Section 1115 demonstration and CalAIM Section 1915(b) managed care waivers. This approval authorized $1.44 billion in one-time funding to aid in transitioning Whole Person Care and Health Homes Program pilots, which leverage care coordination and offer non-medical interventions from Medi-Cal 2020 to CalAIM. This approval also makes way for DHCS to address the needs of Californias most vulnerable residents, provide more equitable programs, and increase access across the state. Key provisions of CalAIM include community supports delivered through community providers; enhanced care management; delivery system transition and alignment; access to and transforming health supports; substance use disorder services and initiatives; supporting coordination and integration for dual eligibles; dental benefits; chiropractic services for Indian Health Service and Tribal facilities; and a global payment program. On any given night over 161,000 people are experiencing homelessness in California and there are stark racial disparities within Californias homeless population; Black people make up 39 percent of Californias homeless population while only making up 13 percent of the states general population. These racial disparities are connected to racist policies like redlining, which resulted in housing, economic, educational, and health inequities. Experiencing homelessness also puts Black people at an increased risk of being justice-involved due to the increased likelihood of interacting with law enforcement. A key aim of CalAIM is to address the needs of individuals experiencing chronic homelessness by providing them with enhanced care management and community supports that offer coordinated and community-based whole person care. Housing related community support includes assisting enrollees with finding and securing housing, assistance with Page 5 securing housing deposits and support maintaining stable tenancy once housing has been secured. In paying special attention to those who face the biggest barriers to accessing stable housing (i.e., those re-entering the community after incarceration) DHCS is better able to reach those most impacted to better ensure successful transition into safe and stable housing. CalAIMs goals to improve access to coordinated health and social services have the potential to positively impact the lives of Black people and promote their health and wellbeing, especially in relation to addressing homelessness and housing instability. Since launching in 2022, initial observations from the roll out of community supports and enhanced care management recognized the importance of outreach and engagement activities and the crucial role that community health workers, peer support providers and those with lived experiences play in engaging those who need these services most.51 Other states may adopt this type of strategy as a means to address social determinants of health in their communities.

Reference

Mosalewa Ani, Program Coordinator, The Network for Public Health Law National Office & M.P.H. Candidate George Washington UniversityMilken Institute School of Public Health (2023); **********************

Instructions

After you have identified a federal, state, or local social policy that impacted clients served by your internship agency, write a policy analysis and advocacy paper that includes the following:

1. Describe a policy that impacts clients.

• Present specific examples to support the description of the policy and its impact on clients.

1. Evaluate the pros and cons of a policy that impacts clients.

• Support the evaluation with specific examples.

1. Describe efforts to advocate for clients by influencing policy.

• Present specific examples to support the description of advocacy efforts.

1. Describe the outcome(s) of advocacy efforts.

• Present specific examples to support the description of advocacy outcomes.