California's $12 Billion Medicaid Experiment Stretches The Definition Of Health Care

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.In these challenging times, the need for reliable local reporting has never been greater. Put a value on the impact of our year-round coverage.

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

Fabiola Sandoval's son, Jorge Sanchez, got a relief from his asthma thanks to Medi-Cal's new funding for social services.The collaborative has served about 3,650 patients, including Sandoval's son Jorge, in eight counties since early 2022, he said. It has years of experience with Medi-Cal patients in the Central Valley and has received about $1.5 million of the new initiative's money.

The 25 managed-care insurance companies participating in Medi-Cal can choose which services they offer, and contract with community groups to provide them. Insurers have hammered out about 4,300 large and small contracts with nonprofits and businesses.

For nonprofits and businesses, CalAIM is a money-making opportunity — one that top state health officials hope to make permanent. Health insurers, which receive hefty payments from the state to serve more people and offer new services, share a portion with service providers. Middleman companies also have their eye on the billions of CalAIM dollars and are popping up to assist small organizations go up against established ones like Mom's Meals. For instance, the New York-based, with 70 member organizations, is helping smaller nonprofit groups develop and deliver services primarily for families and foster children. Full Circle has signed a deal with Kaiser Permanente, allowing the health care giant to access its network of community groups.

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California's $12 billion Medicaid experiment stretches the definition of health careThe 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.
Source: NPR - 🏆 96. / 63 Read more »