California's $12 billion Medicaid experiment stretches the definition of health care

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The state covers basic services for vulnerable residents, including things like air purifiers for kids with asthma. But nonprofits offering the services struggle to work within the health care system.

Alondra Mercado, a community health worker with the Central California Asthma Collaborative, helps provide services through an ambitious California Medicaid initiative. On a recent morning in March, she visited a family in Turlock to teach a mother how to control in-home asthma triggers that cause flare-ups in her young son.Alondra Mercado, a community health worker with the Central California Asthma Collaborative, helps provide services through an ambitious California Medicaid initiative.

The in-home consultation and supplies were paid for by Medi-Cal, California's Medicaid health insurance program for low-income residents.

By contrast, CalOptima Health, Orange County's primary Medi-Cal insurer, is new to offering asthma benefits and has signed up 58 patients so far. "If you want to do this, you have to learn all these new systems," for getting paid through CalAIM, she said."It's been a huge learning curve, and very time-consuming and frustrating, especially without adequate funding."

Mom's Meals has an advantage over neighborhood nonprofit groups because it has long served seniors on Medicare and was able to immediately start offering the CalAIM benefit of home-delivered meals for patients with chronic diseases. But even Mom's Meals isn't reaching everyone who qualifies because doctors and patients don't always know it's an option, said Catherine Macpherson, the company's chief nutrition officer.

 

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