California’s Innovative Efforts to Coordinate Care for Medicaid Beneficiaries

By Tanya Schwartz, Director, Medicaid Policy and Lilly Clements, Junior Policy Consultant

On January 1st, the California Health Homes Program (HHP) rolled out in two additional counties – Riverside and San Bernardino – after first launching in San Francisco in July 2018. San Francisco also expanded its HHP program to serve Medi-Cal members with mental health conditions in addition to those with physical health conditions. Eleven additional counties will implement the HHP in July 2019 – for a total of 13 counties across the state.

The HHP provides extra services to Medi-Cal members who have the highest health care needs. Members are given a care team – including a care coordinator – that works together to connect their health care providers and to facilitate access to a full range of physical health, behavioral health, and social services. These services are provided at no cost to members as part of their Medi-Cal benefits.

HHP services are implemented by Medi-Cal managed care plans, which contract with community health care providers (known as Community-Based Care Management Entities or CB-CMEs) to provide many of the services.

Comparison and Intersection of the HHP and the Whole Person Care Pilots

While the HHP is rolling out across the state, another innovative state effort to improve care coordination of physical and mental health and social services – the Whole Person Care Pilot Program (WPC) – is in its fourth year of the five-year Medi-Cal 2020 Section 1115 waiver program. These two California Department of Health Care Services (DHCS) programs represent similar, but structurally different, efforts to improve the coordination of care for Medi-Cal beneficiaries across the health care system and address their social determinants of health.

There has been state and national interest in how these two California care coordination programs compare and intersect. Harbage Consulting has produced a white paper, Innovative Care Coordination Programs for California’s Medi-Cal Beneficiaries: The Health Homes Program and the Whole Person Care Pilots, that summarizes the HHP and WPC, highlights their similarities and differences, and explains the requirements for Medi-Cal beneficiaries who qualify for both programs to avoid duplication of services.

Harbage Consulting Role

Our team supports DHCS and the Medi-Cal managed care plans on implementation of the HHP and the Whole Person Care pilots. This includes:

  • Facilitating Learning Collaboratives to share best practices on policy and operational issues;
  • Developing outreach and education materials to explain the Health Homes program to beneficiaries, health care providers, and community-based organizations;
  • Conducting on-the-ground HHP education for providers and community-based organizations; and
  • Facilitating technical assistance for the WPC pilots and bringing in subject matter experts to address specific topics of interest.

Harbage Consulting is proud to support implementation of these important programs that seek to improve health outcomes for California’s most vulnerable populations.