Report calls for “paradigm shift” in how Medi-Cal eligible children receive care

A paper from the First 5 Center for Children’s Policy proposes a “paradigm shift” in how the state delivers and finances care for Medi-Cal eligible infants and toddlers. Rather than focusing on delivering individual services, the First 5 Center recommends a “Whole-Family Wellness Hub-and Spoke Model” to meet the needs of young children. 

The new model would put an emphasis on prevention, early identification, and support to bolster the health of children in a model that is “grounded in family wellness” and concentrated in community settings. This model would provide care through a broad range of providers such as community-based organizations, FQHCs, county-operated clinics, and primary care practices. These would serve as the “hubs” where providers would work together to provide peer-support and models for attachment and bonding. The “spokes” would come in the form of resources that address broader social needs. 

 

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According to the report, California’s current model of care does not adequately meet the needs of children on Medi-Cal because there isn’t a focus on family care. 

“Children’s physical health, as well as their social, emotional, and cognitive competence, require secure attachments to emotionally invested and protective adults who have the knowledge and psychological readiness to provide safe, stable, and developmentally appropriate care. Decades of empirical research confirm the importance of parental care in predicting child outcomes,” reads the report. 

“Supporting the healthy development of young children necessitates supporting their parents’ ability to provide adequate care.”

To establish this comprehensive wellness benefit during early childhood, the report identifies three transformations that need to take place within the Medi-Cal system:

“1. Ensuring access to Whole-Family Wellness Hubs that support family wellbeing through peer support, attachment and bonding, and understanding of social determinants of health. Hubs would focus on social and emotional support, as well as linkages to community-based services and supports, from the onset of a child’s life.

2. Prioritizing the training and retooling of the early childhood wellbeing workforce to understand and address issues in the context of community, social justice, and family wellbeing.

3. Creating a financing model with a capitated rate that supports providers to address children based on need in the context of their family, their extended family, and their community.”

In the current Medi-Cal system, a child needs to be diagnosed with an illness to receive a covered mental health service. The researchers who created the report argue that this system encourages inaccurate and premature labels, and can result in ignoring the real needs of some families that do not meet a strict clinical criteria — such as those experiencing economic stress, parental mental illness or substance abuse, community violence, or inequities. 

Funding this model would require the “utilization of multiple sources of siloed funding” such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) funding, Realignment funding, General Funds, and Mental Health Services Act (MHSA) dollars. The researchers recommend utilizing a capitated rate model for behavioral health and highlight four specific funding strategies:

“1. Implement a Well Family Provider Incentive payment to providers via MCOs to bolster EPSDT behavioral health screening and timely care coordination of services, and promote appropriate utilization of services covered under the Mild and Moderate Behavioral Health Benefit—obligations under their current contract with DHCS.

2. Amend existing Proposition 56 VBP Initiative for Behavioral Health to allow for investments consistent with this model. Currently, the proposed behavioral health integration metrics are limited to Healthcare Effectiveness Data and Information Set (HEDIS) outcomes and do not target social-emotional outcomes.

3. Use the MHP capitation allowances of Title 9 and amend MHP contracts to scale this behavioral health funding model in all California counties using MHSA or allowable Realignment funding as the non-federal share. Medical care would remain a separate capitated benefit.

4. Use the upcoming 1915b/1115 Waiver negotiations to propose a dedicated Early Childhood and Family Wellness pilot and directly fund the Hubs as a component of a broader Behavioral Health Delivery System Reform Incentive Program (DSRIP) or advance a Health Homes-like model for children, to bolster the ability of community-based providers to offer care management services (navigation, support, health education) to families.”