This edition includes recommendations on using emergency department discharge data to improve service delivery to the homeless, insights on how presumptive Medi-Cal eligibility can be used as a means to enroll individuals in full Medi-Cal coverage, and collaborative reporting between Molina Healthcare and MedZed which successfully reduced hospital utilization rates in San Diego County.
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Status of Changes
1. ED discharge data can be used to improve care for the homeless
A new report from PPIC encourages the state to use emergency department data on homeless people (these people represented 4% of all ED visits in California in 2019) to connect them with social assistance services. With 90% of 2019 ED visits by homeless individuals covered by Medi-Cal or Medicare, the report also encourages linking administrative data to other social services to improve coordination of care for these populations.
The report found that nearly 40% of 2019 ED visits by the homeless resulted in a mental health diagnosis, and 30% resulted in a drug-related diagnosis. The most common diagnoses were schizophrenia and mood disorders. By identifying these people through discharge data, the report says, the state can connect them with needed behavioral health services.
2. The power of presumptive eligibility to fully expand Medi-Cal coverage
Presumptive Medi-Cal eligibility (PE) can be a useful tool to get more eligible Californians enrolled in full Medi-Cal coverage, according to CHCF. Their recent report cited several barriers that hospitals face in getting eligible patients fully covered by Medi-Cal, including patients not understanding the importance of ongoing Medi-Cal coverage, unnecessarily long Medi-Cal applications, and barriers related to COVID.
CHCF offered solutions, including openly talking about expanding state Medi-Cal eligibility for undocumented immigrants, making Medi-Cal applications easier, and ensuring collaboration between hospitals and state programs to streamline the state’s application process. The report also recommends allowing CBOs to make PE decisions and improving PE data collection so that inequities in the application process can be more easily identified.
3. Audience: Lucy Marrero, Gold Coast Health System
In this edition of our “What They’re Watching” video series, Lucy Marrero, Director of Behavioral Health and Social Services for the Gold Coast Health Plan, discusses her work to improve access to behavioral health in California. She believes that school-based health support is key to addressing youth behavioral health issues.
He emphasized the Student Behavioral Health Promotion Program, in which the Gold Coast Health Plan partners with Ventura County and local school districts to increase access to behavioral health care for youth in schools. “The children go to school every day,” she said. “They have relationships with teachers, administrators, [and] school counselors, and that relationship can be very strong … building relationships with our schools I think is very important for us.”
4. MedZed’s partnership with Molina successfully reduced hospital utilization rates
According to MedZed Co-founder and CMO Neil Solomon, MD, his organization’s partnership with Molina Healthcare has reduced hospital utilization in the San Diego area. The program aims to help people with complex needs become medically stable by connecting them with professionals, addressing community needs such as housing and food insecurity, and helping them navigate the health care system.
Solomon said the ultimate goal is to send program participants back to their primary care provider once their results improve. “We are very focused on people where health equity is a big part because many of these people have never had a very good experience with the health system, they could not really feel the love of this system,” she said. “We really find a way to connect with them—we have people from their communities who help them and get to know them and support them in ways that allow them to be more successful in their lives and their lives.”
5. The provision of services for the elderly that do not meet the growing demand
A recent study from the UCLA Center for Health Policy Research revealed that only 38,373 of about 243,000 Medi-Cal recipients were eligible for California’s Multipurpose Senior Services Program and Community-Based Senior Services offered in 2020. Black/African American and multiracial populations are underrepresented in the population to receive services.
“As the state continues to implement the Master Plan on Aging, it is critical to address gaps in access to long-term services and supports,” said Center for Health Equity Program Director Kathryn Kietzman. With the need for these services for older adults expected to continue to grow in the future, the report encourages awareness of this unmet need, addressing inequities in access to these services, and ensuring that providers are available in all geographic regions.