5 Things California: What You Missed, CalAIM update, CHW amendment


Eli Kirshbaum


We were delighted to see many of you at the 2021 Southern California State of Reform Health Policy Conference last week. After so many months in the virtual space, it was incredibly refreshing to host an in-person event where stakeholders could have thoughtful, face-to-face conversations on state health care policy. Thank you to all who joined us and made the event possible. See just a few of the conference’s many highlights below.

I also want to note that registration just opened for our 2022 State of Reform Federal Health Policy Conference, which we will host virtually on Feb. 17. Early Bird registration ends this Friday, so be sure to take advantage of the discounted price and secure your spot!

Thanks for reading!

Eli Kirshbaum
State of Reform 

1. Keynote: Sup. Fletcher on polarization, BH reform, and health care privatization

Sup. Nathan Fletcher began his Lunch Keynote last week by scrutinizing today’s polarized politics and said he wants to see the country “return to a place where it’s okay to disagree.” He also criticized San Diego County’s “messy” seven-plan Medi-Cal managed care model and said it’s not yielding nearly as effective outcomes as other counties’ two-plan models.

Fletcher said behavioral health integration—something he believes is essential—hasn’t moved forward in San Diego County because of the stigma that surrounds it. “We don’t view it as health. We don’t fund it, staff it, cite it, reimburse it, we don’t workforce it … And a lot of that is the stigma that is associated with issues of mental health illness.”


2. What They’re Watching: Norma Diaz, Community Health Group

In the first edition of our “What They’re Watching” interview series from the Southern California conference, Community Health Group CEO Norma Diaz shares how her organization is laser-focused on serving its members above all else.

Diaz says she makes a point to periodically visit members’ homes to see their living environments firsthand, giving her an awareness she says is key to designing member-centric services. “If I don’t go out to their homes and I don’t feel what they feel, then I don’t know that I can come up with the best initiatives to serve them.”



3. DHCS spokesperson gives update on CalAIM preparation

During a panel at last week’s conference, DHCS’s Aaron Toyama told the audience that he has no concerns about the 1915(b) waiver needed to move forward with CalAIM and is “pretty confident” CMS will approve it before the end of the year.

In response to inquiries about the technology platform for CalAIM’s population health management strategy, Toyama said a lot of work remains but DHCS hopes to have a platform procured and operational by the strategy’s go-live date of Jan. 23. “We envision it to be phased [in] in terms of functionality,” he said of the platform rollout. He also clarified that DHCS isn’t specifying how plans and providers should share financial responsibility for the ECM managed care benefit.


4. Proposed State Plan Amendment for CHWs is too limited, stakeholders say

As DHCS develops a State Plan Amendment to cover community health workers and promotores through Medi-Cal, stakeholders are saying the department’s proposed SPA design is too restrictive. At a recent CHCF webinar, CPEHN’s Kiran Savage-Sangwan said DHCS needs to enforce alternative payment models that cover a wider array of CHW/P services, rather than using a narrow fee-for-service model.

Other speakers on the webinar called on DHCS to omit the SPA’s educational and certification requirements for CHWs, saying they would make it more difficult for qualified individuals without the finances to complete certification courses or who don’t speak English to enter the CHW/promotore workforce. After incorporating stakeholder input, DHCS intends to send a finalized SPA to CMS in March 2022.

5. Evaluating state-run dually eligible demonstrations

Creating a consolidated system of care for dual eligibles would have a “substantial payoff,” says State of Reform columnist James Capretta, but reaching consensus on how to streamline the two public health insurance services for dual eligibles has proven to be a challenge. In his most recent piece, Capretta explains several state approaches to managing dual eligible care that policymakers can learn from when crafting a national solution.

Capretta points out that California’s test of a “fully capitated” financial alignment initiative, in which the state and the federal government make one-time payments to managed care plans to cover the full cost of care for dual eligibles, has increased Medicare spending relative to what it would have been without the initiative. “Faster progress may require … a mandate for a fully integrated benefit administered by the states or the federal government,” he said.