California's Medicaid program overhaul is improving access to social services, but many health plans, nonprofit community organizations and other stakeholders say reimbursement rates are not covering the full cost of services.
Around half of those tasked with implementing the program say overall access to services, including those for social determinants of health, have gotten somewhat or much better as a result of CalAIM, according to a report from the California Health Care Foundation published Dec. 5.
CalAIM, which was first implemented in January 2022, is a multiyear initiative designed to integrate Medicaid with other social services, addressing social determinants of health through housing, transportation and other supports. The program also provides Medicaid beneficiaries with complex conditions with personal care managers and includes an overhaul of the state's managed care contracts.
The California Health Care Foundation surveyed 1,196 people working on implementing the program, including employees at managed care plans, behavioral health organizations, and community-based organizations.
The biggest challenge those surveyed reported was payment rates not covering the full costs of services. Over half of respondents, 56%, said these rates were "very or somewhat challenging."
Around half of respondents said their ability to manage beneficiaries' comprehensive needs has improved through CalAIM, while 40% said this has remained around the same, or they are unsure.