California’s Medicaid experiment spends money to save money — and help the homeless

SAN DIEGO – Craig McEwen, a former NFL star who won a Super Bowl ring in the late 80s, does not fit the stereotype of someone on the verge of homelessness.

McEwen, who suffered repeated concussions in his NFL career of six years, was evicted last July from his San Diego County apartment. He searched the housing listings to find something he could afford.

His frantic search for a job as a groundskeeper on a golf course, earning $15 per hour, turned up no results. He was overwhelmed by the $3,000 monthly rent for a 1-bedroom apartment. So he decided to move into his truck, or rent a container.

McEwen hopes that a California health care initiative offering new and specialized social services can help him get on his feet. He is among nearly 145,000 low income Californians CalAIM is a program that allows you to enroll in CalAIM.Gavin Newsom is the Democratic Governor of California. He has been leading an effort to transform Medi-Cal (the state’s Medicaid program) into a new safety net for those who are homeless, or at risk of being homeless, and suffer from conditions such as mental illness and chronic diseases that make life difficult.

California began the initiative quietly in 2022. Health insurers and community organizations scrambled to provide services and benefits outside of traditional health care. Newsom believes that a $12 billion, five-year social experiment will help to reduce the escalating health care costs in Medi-Cal. Medi-Cal is the nation’s largest Medicaid program with over 15 million participants.

The state contracts the work out to its Medi-Cal managed care health insurance companies. The companies are responsible for providing a variety of new benefits to enrollees, including those with housing insecurity as well as people with mental illness or addiction disorders. They also provide services to seniors and people with disabilities.

Only a Only a small fraction of Medi-Cal recipients in the state are enrolled CalAIM could provide new benefits to tens or thousands of Californians with low incomes. The new benefits include help with finding housing, and paying for rental move-in fees like security deposits.

The help extends beyond housing. Along with housing, the state also provides intensive case management to those most at risk. pioneering social services Healthy home-delivered food for diabetic patients Mold removal Patients with severe asthma can be treated at home.

Top health officials in the states say they expect a bumpy rollout of such an ambitious program, which uses Medicaid to combat chronic diseases and homelessness. After 2026 When the funding of an initiative endsThe state intends to demonstrate that the experiment is successful and adopt its benefits permanently. California is closely watched by other states, who hope to learn from the successes and failures of California.

Dr. Georges Benjamin is the executive director of American Public Health Association. He said that California was a leader and always experimented in interesting and new ways. “What California can do is prove the concept and then spread to other states,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

The insurers are in effect building a new workforce of health care workers, by contracting with non-profit and for-profit groups to enroll Medi-Cal’s most vulnerable — and costly — patients. They hire social workers and case manager to identify those patients who incur extreme medical costs in emergency rooms of hospitals, nursing homes and prisons.

Newsom believes that the taxpayers will reap the benefits of this massive investment. He argues that targeting people who cycle in and out expensive institutions will help reduce health care costs while helping people to get healthy. Health officials in the state say that 5% of Medi-Cal high-need patients are responsible for 80% of all health care costs. About half of the total health care expenditure In the low-income health program.

Trust is the most important currency to pull off this massive experiment in health care. This trust is built by community outreach workers who scour hospitals and homeless camps, for example, in order to identify those who are eligible for CalAIM.

A new entitlement benefit, “The Initiative”, is aimed at ensuring that the most vulnerable Medi-Cal patients have access to specialized teams.Enhance care managementOther services are available Like covering security deposits This is not optional. The health insurance companies must accept people with disabilities. Most in Need They also provide a variety of social and health services.

Simple things can include arranging for an Uber to take you to your medical appointment, or purchasing a computer for a student looking for work. You could buy a bike for an underprivileged child. It also requires intensive one-on-one case management, which can include taking patients to obtain an identification card or making night-time phone calls to make sure patients are taking their medications.

Newsom told KFF Health News that “this is the missing part, and the hardest — the most expensive work.” “People are losing trust on the sidewalks and streets. They have become socially isolated. “They’ve lost their connection and developing that is foundational.”

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“My Own Prison”

McEwen was the tight end of the NFL team The Washington Commanders, and then the San Diego Chargers were the original names of the team. Hailed as a legacy. The physical and mental toll of playing professional football is extreme.

McEwen recalled that, back then, it was okay to hit someone in the head. He would get out of concussions by smelling ammonia packets. McEwen led the Washington team to Super Bowl glory in 1987. However, in the years since, his health deteriorated.

McEwen, who played football for many years, has been struggling to find a regular job. He also struggles with depression, anger, forgetfulness and thoughts of suicide. McEwen believes that these symptoms are the result of traumatic brain injury sustained during his career. He is 57 years old and suffers from chronic pain due to ruptured disks of his neck and back, as well as shortness in breath caused by severe heart disease.

He had been cooped up in his apartment, with his curtains nailed on his windows. He drowned his pain with alcohol. He said, “I created my own jail.”

A longtime friend of his offered to temporarily let him stay in the spare bedroom in his family’s home just outside San Diego after he was evicted in July. McEwen continues to struggle financially and emotionally with finding stable housing.

“We don’t refer to it as fear. “We ballplayers call it excitement,” McEwen told reporters on a rainy day in early March. His eyes were brimming with tears. “I’m excited. I know what is at stake. “My life is on the line.”

Instability in the housing market is only one aspect of this. He would often forget to take the medication he needed for high cholesterol or clogged arteries. He was paralyzed by anxiety, and his brain would be so scrambled that he would miss important doctor’s appointments.

McEwen was aware that he needed assistance.

He had learned from a close friend that California helped Medi-Cal recipients with both medical and social needs. So he began calling, insisting to be admitted. I said, “Wait, you are giving people a Coach?” “Can you send me to appointments and accompany me on my doctor’s visits?”

Photo of a man pointing at his calendar application on his smartphone.
Craig McEwen, a former NFL player who suffered brain injuries during his career, has missed doctor’s appointments and failed to take his medication. He keeps track of all his medical needs in a calendar that he shares his Medi-Cal Care Manager.(Angela Hart / KFF Health News)

After receiving the eviction notice from his Medi-Cal insurance, Molina Healthcare connected McEwen with a personal caregiver, whom McEwen describes as “my advocate. Someone who can teach and guide me to live a fulfilling life.”

It is not uncommon for people to be randomly selected into the Medi-Cal program. This is due in large part to the Medi-Cal company they are enrolled with. Persistence is key.

The rollout, despite early signs of optimism, has been chaotic. The providers on the ground are scrambling to find housing for the enrollees. The groups implementing the initiative claim that inadequate funding and a severe shortage of health workers have made it difficult for them to provide services to all those who are in need. Health insurers are also uneven in their enrollment, with some approving benefits quickly for members and others being denied. Some health insurers offer Uber on-the spot for doctor’s appointments, while others only provide a bus ticket.

“What’s being offered is inadequate, and this program does not support those who need the most intense support,” said Nancy Behm. She is the associate director of CalAIM, a San Diego-based nonprofit called People Assisting the Homeless. PATH.

PATH began providing intensive case management services and housing in January 2022, under contracts with Blue Shield of California and Molina Healthcare. It has stopped offering intensive case management services, largely because of a lack in funding. Behm stated that “we’re facing barriers on all fronts”.

Newsom, with His soaring political aspirationsCalifornia’s most vulnerable citizens will be helped by. The speculation that the two-term Governor is considering a presidential bid in 2026 is growing. He’s using health insurance as a key issue to raise his national profile. In reality, Medi-Cal is a far cry from what the two-term governor had hoped.

Doug Herman who previously worked for Barack Obama, former Los Angeles mayor Eric Garcetti, and the former president of the United States, said that the program was ambitious, but did not help the entire population. “This is not a big enough policy solution to make a real dent in the homelessness problem.”

No Walk in the Park

Jeannine Nash who works at Serene Health, San Diego, helping homeless people find housing and treatment, surveys encampments as she makes her way to the office, distributing water and food to those in need.(Angela Hart / KFF Health News)

Jeannine Nash stopped at the drive-thru window of a Jack in the Box in Chula Vista in late February. The restaurant is located just south of San Diego. She reached into her wallet and found $8.17 to buy 10 breakfast sandwiches that she would give to homeless people when she visited encampments on her usual rounds.

“It’s helpful to me to come here before I go to work to get an understanding of the needs,” Nash explained as she approached a homeless woman who was slumped on a pavement. She had only a new walker with her and some hospital discharge papers tucked into a plastic bag.

Nash is the director of referrals at Serene Health. This for-profit company is one of more than 500 organizations that are paid to connect homeless people and those who may be at risk to intensive case management services, housing, or other services.

Nash, a recovering addict, said that her own life experience helped her to connect with those outside who are struggling with substance abuse disorders. She finds ways to convince those who are resistant to accept help. Nash, whose son is homeless, said that “so many people distrust authority”.

Nash stated, “This is something that I hold very dear.” She has acquired a wealth of experience in the decades she’s been sober. She knows how to get people who are most at risk into treatment beds, and sometimes even apartments. She has developed relationships with agencies that provide housing and nursing homes so she can identify openings quickly.

Her job is not without its challenges. She has to tell people who live outside that there are no other options for them. She said, “There aren’t enough beds or houses out there.” “And without an income it won’t happen.”

Nash gave the woman two sandwiches and encouraged her to eat. Christina Gallegos (38), a woman suffering from severe liver damage as a result of chronic drinking, had crawled a few blocks to Scripps Mercy Hospital, Chula Vista where she had been discharged just the night before.

Photo of a woman who is homeless sitting down and staring into a bag containing supplies. She is being watched by another woman.
Christine Gallegos was homeless with liver failure and discharged in February from the Scripps Mercy Hospital, Chula Vista in California. She had nowhere else to go. She claims she crawled under a nearby doorway to find shelter.

Her hospital discharge papers showed that she had visited the emergency room several times in the last month. She was given a walker, but she couldn’t move and had to drag it through a doorway as shelter.

We see it all the time. “It’s getting bad,” Nash texted her contacts, asking them to find a place for Gallegos. “She is definitely eligible.” “It’s going to be difficult to find a place for her to live.”

Gallegos is a Medi-Cal recipient, but she has not been enrolled for the new benefits California offers. In 2022, she was one of an estimated 8,500 people who were homeless in San Diego County. This is a 10% rise since 2020.

San Diego County has a large population and is dotted with homeless camps. However, the majority of homeless people live in San Diego’s downtown area and its parks.

Balboa Park, near the San Diego Zoo, is a popular spot to pitch a camp. Tent communities are scattered throughout the park’s canyons and green expanses. Residents plead with community groups for assistance. Some people keep business cards of homeless outreach workers, hoping to get a permanent home or a shelter. Many people feel that outreach efforts are a broken promise, even though some do find housing.

David Lloyd pulled out of his pocket the phone number of an outreach worker at the homeless services provider PATH. The outreach worker told David that he had been placed on a housing waiting list, but that it could take him years to get a place.

Lloyd, aged 66, said: “It is a long list.” “I want to be off the streets. “I’m tired of cops harassing and threatening me.”

Cally Wood, 35 said that she was addicted to fentanyl. She has been waiting for housing on the list for over a year. She said, “It feels impossible.” “There is nothing affordable.”

Health insurance executives including Martha Santana Chin, Medi-Cal President for Health Net California, say Medi-Cal managed care plans are helping to get people off of the streets and in services. She acknowledged that the initial rollout is not satisfactory.

Santana Chin said that the housing stock is not sufficient to ensure that those who require support and services will be permanently housed.

Sweeps a hindrance

San Diego County is experiencing an increase in homelessness. The official count estimates that there are about 8,500 homeless people. This represents a 10% rise since 2020. However, officials admit that the numbers could be much worse.(Angela Hart / KFF Health News)

In the entire region, sweeps are conducted to remove homeless camps. This is becoming a part of daily life for those who live outside. The deteriorating and unsanitary conditions of the streets are a source of public frustration.

Newsom has intensified the clearing of encampments. He argues that homeless people should not be permitted to live outside, despite the lack of alternative housing. He is allocating state funds to cities and counties for the removal of tents on streets and sidewalks, and moving people into shelters or housing that are available. San Diego’s Mayor Todd Gloria is also a Democrat and has no qualms about taking this approach.

Gloria said to KFF Health News, “We are doing the necessary cleanups for public safety.” These conditions are unsafe and put people’s safety and health at risk. They can even lead to death. I have heard people disagreeing with me, claiming to care for the individuals. But the sidewalk is not their home.

The crackdown on enforcement, according to outreach workers, only makes their job harder. The new Medi-Cal initiative has as one of its most important goals to visit homeless people regularly, develop relationships with them and assist them with their health care needs while also preparing them for housing, if any becomes available.

This really takes a long time. You can start by giving someone a pair of socks or a water bottle. Andrea Karrer is a PATH outreach worker. She said that it can take up to 70 encounters before someone accepts our help. When someone is constantly moving, it’s hard to trust them. You have to start over and find the person again.

She and other outreach workers stated that the disruptions cause people who are without housing to become sicker and more likely to visit the ER.

When you move every two to three days, going to the doctor and taking your medication are not top priorities. “You’re in survival mode,” Karrer explained.

Work-intensive Effort

Serene Health enrolls Medi-Cal patients in intensive case management. According to California’s Department of Health Care Services which administers MediCal, together they have registered 108,000 patients in the state. Additional 28,000 people are now receiving housing services, such as assistance with locating affordable housing and security deposit payments.

Jacey Cooper is the Medicaid director for the state. She stated that all 58 counties are covered by health insurance, but acknowledged that there is a need for more housing.

Cooper stated that it takes time for the infrastructure to be developed. This is especially true for Medi-Cal patients, who are frequent ER visitors. We are in the midst of a massive educational moment, ensuring that people know who is eligible, how to refer and educating everyone involved, from hospitals and providers.

Newsom has asked the Biden administration to allow him to add a new housing benefit. Cover up to 6 months Direct rent payments

A woman poses for a photo at a computer desk.
Veronica Ortiz works as a care manager at Serene Health, based in San Diego County. She is currently working on CalAIM in California, a new MediCal initiative that integrates social services with the state’s Medicaid Program.(Angela Hart / KFF Health News)

Veronica Ortiz is a Serene Health lead care manager. She has about 60 patients on her list, including Craig McEwen. This is a large number of cases that are difficult to manage.

Ortiz is full of compassion and energy. She says that working with McEwen and other patients has made her more determined to make a change. She said that McEwen has become more independent.

“When we enter their lives, they are strangers. We have to spend time with them face-to-face and help with whatever they need. Otherwise, they won’t trust us.”

Donna Fontenot is being evicted this month from her apartment in San Diego County. Her landlord informed her that she was being evicted from her apartment due to repeated ER visits, hospitalizations and skilled nursing facility stays following a fall in 2022 which left her in a wheel chair.

Fontenot stated, “I am terrified and completely panicked. I have nowhere to turn.” One hospitalization costs approximately $4,000 California averages $18,000Fontenot has a high medical bill because he is on Medi-Cal.

She said that she has been hospitalized 8 times since March 2022. On five occasions, the injuries she sustained to her legs and feet were severe enough that she required placement in a nursing facility.

But her Medi-Cal insurance company, Community Health Group of San Diego, has imposed a requirement that she have a child younger than 18 to be eligible for certain housing services. She is not receiving the housing assistance she could use. She is enrolled, however, in intensive casemanagement. She was unaware of this until KFF Health News told her.

She said, “I feel as if I’ve won the lottery.” “Will it help me?”

Photo of a woman sitting in a wheelchair for an indoor portrait.
Donna Fontenot has been hospitalized multiple times over the last year because of serious injuries caused by a fall. She has accumulated a large amount of medical bills despite being enrolled in MediCal. Her San Diego County apartment is now being evicted. She hopes to get help from a Medi-Cal benefit known as “enhanced Care Management.”(Angela Hart / KFF Health News)

She hasn’t had a care manager as involved with her as Ortiz was in McEwen’s life. Fontenot is still searching for housing on her own and has recently requested to be transferred to Serene Health in order to receive more assistance. “I have never needed assistance like this before. “I feel so broken,” said the woman in tears. “Where am I going?”

Ortiz has been helping McEwen find a home. She has also focused on helping McEwen get his heart condition in check and find stable work.

He was hired as a security officer to patrol sporting events in March, including football stadiums. He also got a difficult-to-get appointment to have surgery late this month in order to unclog his heart’s arteries.

“Before Veronica I was waiting to Die. I was drinking and eating to death. She showed up for me. Someone cares about me. McEwen: “It was then that I had the courage to tell her my dream. “I thought that I would be more valuable if I was loved by football.

I now know that my purpose in life is to serve and be with my daughter. I decided to return to the field instead of just sitting on the sidelines.

A woman and man are pictured hugging in front of a restaurant.
Craig McEwen & Veronica Ortiz(Angela Hart / KFF Health News)

This article has been produced by KFF Health NewsThe. California HealthlineThe Independent Service of the California Health Care Foundation.

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