This edition features recommendations about using emergency department discharge data to improve service delivery for unhoused individuals, insight about how presumptive Medi-Cal eligibility can be used as an on-ramp for enrolling individuals in full Medi-Cal coverage, and reporting on a partnership between Molina Healthcare and MedZed that is successfully lowering hospital utilization rates in the San Diego region.
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Eli Kirshbaum
State of Reform
1. ED discharge data can be used to improve care for the unhoused
A new report from PPIC urges the state to leverage unhoused individuals’ emergency department discharge data (these individuals represented 4% of all ED visits in California in 2019) to connect them with social support services. With 90% of 2019 ED visits by unhoused individuals being covered by either Medi-Cal or Medicare, the report also encourages linkage to other social services’ administrative data to improve care coordination for these individuals.
The report found that nearly 40% of 2019 ED visits by the unhoused resulted in a mental health diagnosis, and 30% led to a drug-related diagnosis. The most common diagnoses were schizophrenia and mood disorders. By identifying these individuals through discharge data, the report says, the state can connect them with needed behavioral health services.
2. Presumptive eligibility’s potential to increase full-scope 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 listed several obstacles that hospitals face in onboarding eligible patients to full Medi-Cal coverage, including patients not understanding the importance of ongoing Medi-Cal coverage, unnecessarily lengthy Medi-Cal applications, and COVID-related obstacles.
CHCF offered solutions, including clearly communicating the state’s recent Medi-Cal eligibility expansion for undocumented immigrants, simplifying Medi-Cal applications, and ensuring coordination between hospitals and state systems to make the state’s application process more efficient. The report also suggests allowing CBOs to conduct PE determinations and improving PE data collection so disparities in the application process can be identified more easily.
3. What They’re Watching: Lucy Marrero, Gold Coast Health Plan
In this edition of our “What They’re Watching” video series, Lucy Marrero, Director of Behavioral Health and Social Programs for Gold Coast Health Plan, discusses her work to improve behavioral health access in California. She believes school-based behavioral health support is key to addressing the state’s youth behavioral health crisis.
She highlighted the Student Behavioral Health Incentive Program, through which Gold Coast Health Plan works with Ventura County and local school districts to increase behavioral health care accessibility for youth in schools. “Children go to school every day,” she said. “They have relationships with teachers, administrators, [and] school counselors, and those relationships can be very strong … building partnerships with our schools I think is extremely important for us.”
4. MedZed and Molina partnership is successfully lowering hospital utilization rates
According to MedZed Co-founder and CMO Neil Solomon, MD, his organization’s partnership with Molina Healthcare has lowered hospital utilization rates in the San Diego area. The program aims to help individuals with complex needs become more medically stable by connecting them with specialists, addressing social needs like housing and food insecurity, and helping them navigate the healthcare system.
Solomon said the ultimate goal is to send program participants back to their usual source of care once their outcomes have improved. “We really focus on a population where health equity is a huge piece because many of these people have not previously had very good experiences with the healthcare system, they haven’t really felt the love of the system,” he said. “We really find a way to connect with them—we have people from their own communities who are helping them and getting to know them and supporting them in ways that allow them to become more successful in their health and in their lives.”
5. Provision of older adult services not meeting growing demand
Recent research from the UCLA Center for Health Policy Research revealed that only 38,373 of the likely 243,000 Medi-Cal recipients who were eligible for California’s Multipurpose Senior Services Program and Community-Based Adult Services were served in 2020. Black/African American and multiracial individuals were the least likely demographic to receive services.
“As the state continues to implement its Master Plan for Aging, it is critical that gaps in access to long-term services and supports are addressed,” the Center’s Health Equity Program Director Kathryn Kietzman said. With the need for these older adult services expected to continue increasing in the future, the report encourages raising awareness about this unmet demand, addressing disparities in accessing these services, and ensuring providers are available in all geographic regions.