5 Things California: Asm. Waldron’s health priorities, Aetna & Community Supports, HCBS data gaps


Eli Kirshbaum


This is the last California “5 Things” newsletter of 2021. What a year it has been—everyone inside and outside of the health policy space faced numerous challenges this year as the pandemic continued to disrupt “normal” life. From our team to you, thank you for all of the work you do to keep your community safe and improve California health care. We are so appreciative of your continued engagement with us.

In light of the rising concern surrounding the Omicron variant, we hope you stay safe during the holidays.

Next month we will see the rollouts of CalAIM’s first programs. Enhanced Care Management, Medi-Cal Rx, and Community Supports—which we feature below—all go into effect on Jan. 1.

Thank you, as always, for reading. Happy holidays and see you next year!

Eli Kirshbaum
State of Reform 


1. Asm. Waldron discusses 2022 health policy priorities

Asm. Marie Waldron plans to focus on the behavioral health workforce and county-level substance abuse treatment in the upcoming legislative session. Calling the state’s current behavioral health system “disappointing,” she hopes to turn her interim work with the Behavioral Health Workforce Strategy Group into policy to support the waning workforce.

In this Q&A, Waldron previews some of her policy priorities for when the legislature reconvenes on Jan. 3. She plans to build on her work from AB 653 last year, which established a grant program for counties to provide behavioral health treatment services. “Our goal this year is to get that grant funded. So we set up the framework, and now we’re going to be working for the funding through the budget so that counties can access the grant to support ongoing substance use treatment programs.”


2. Aetna will offer all 14 CalAIM community supports starting in January

When DHCS operationalizes CalAIM’s Community Supports next month, Aetna Better Health of California will begin offering all fourteen of the optional benefits. Verne Brizendine, CEO of the MMC plan, said one of his main priorities in preparing to offer these benefits is ensuring community organizations—some of which don’t have experience providing health care—can effectively collaborate with providers and health plans to offer CalAIM’s whole person care benefits next month.

Brizendine was transparent about this being a challenging undertaking, but is nonetheless optimistic about the impact they will have on the social determinants of health. “There was some debate about whether we could do all 14 … I don’t anticipate that everything’s going to be perfect on day one, but whatever we run into, we’ll fix immediately and move forward,” he said. Community Health Group Partnership Health Plan is the only other plan that will offer all 14, but will use a phased approach, offering some starting in January and some starting in July 2022.

3. What They’re Watching: Gary Rotto, SDSU School of Public Health

This newsletter’s “What They’re Watching” video features Gary Rotto, faculty member at San Diego State University’s School of Public Health. During our 2021 Southern California State of Reform Health Policy Conference earlier this month, Rotto sat down with us to share his thoughts on Community Supports and public health.

Rotto said the pandemic has revealed a significant underfunding of California’s public health system and called for an increase in this workforce. “As hardworking as everyone has been, they have been overwhelmed. And we know that we need more public health professionals,” he said.


4. CHCF highlights gaps in HCBS data collection

A recent CHCF report found gaps in California’s data collection for the home and community based services it provides. A lack of data on HCBS usage by those who qualify, CHCF says, makes it difficult for the state to increase service uptake and address equity gaps.

One of the several barriers the report cited is that the state has multiple authorities governing HCBS services—demonstration programs, the Medicaid State Plan, and Medicaid waivers. This “patchwork” of HCBS programs not only renders certain services available to only certain areas of California, but also impedes the state’s ability to develop a comprehensive HCBS data collection system, says CHCF.

5. 9.7% increase in US health expenditures in 2020

CMS’s Office of the Actuary’s National Health Expenditures Team recently released their annual report on national health spending, which shows significant pandemic-induced changes in U.S. health care spending last year. In his most recent piece, State of Reform columnist Jim Capretta breaks down some of the report’s main findings about changes in national health care expenditures during 2020.

Overall national health expenditures increased from $3.8 trillion in 2019 to $4.1 trillion in 2020. The private sector spent 0.6% less on health care in 2020 because employers paid less for employee health care due to the large number of people who lost their jobs, Capretta explains. He also notes that since the federal government increased their share of Medicaid spending in response to the pandemic, state health care expenditures decreased by 3.1% in 2020 compared to 2019.