CALIFORNIA FOUNDATION FOR IDEPENDENT LIVING CENTERS STATEWIDE MEETING Money Follows the Person Rebalancing Initiative: California Community Transitions CALIFORNIA FOUNDATION FOR IDEPENDENT LIVING CENTERS STATEWIDE MEETING FEBRUARY 27, 2016

CCT Overview Primary goal is to reduce the number of Medi-Cal recipients receiving long-term care (≥ 90 days) in inpatient facilities by arranging for the use of home and community-based (HCB) services. Local care coordination organizations work directly with willing and eligible individuals to transition them back home or to the community.   CCT Project services are funded through Sept. 30, 2020.  CCT transitions to be performed through December 31, 2018 CCT follow-up services to be performed through December 21, 2019 

Total Number of CCT Transitions

CCT Transitions by Provider Type Other Community Organizations” include multi-service organizations, such as SCAN, IOA, EBI and RSNC, etc.

CCT Participants by Target Population The tracking of target populations is based off primary reported condition by LOs and generally CCT enrollees have multiple chronic conditions including behavioral and mental health diagnosis coupled with other medical disabilities. However, as a result of CMS requirements for CCT reporting, mental health as the sole diagnosis is minimal. Although Elderly individuals constitute 82% of CA’s nursing facility population, the majority of CCT transitions have been individuals with physical or developmental disabilities. Transitioning Elderly individuals is often challenging because they tend to require more medical care, supervision, and HCBS LTSS.

CCT Post-Transition HCBS IHSS – In Home Supportive Services NF/AH – Nursing Facility / Acute Hospital Waiver Other Waivers = AIDS, MSSP, Specialty MH Consolidation Program (SMHCP) ALW – Assisted Living Waiver DD – Developmentally Disabled

Housing Outcomes by Target Population Home Apartment ALW Group Home Elderly 13% 30% 57% 1% PD 18% 60% 22% DD/ID 7% 8% 0% 85% MI 23% 41% 36% All 4 Target Populations 25% 26% DD/ID transitions rely on group homes; whereas, Elderly, Physically Disabled, and Mental Health transitions return home, live in apartments, or transition to the ALW.

1-year CCT Post-Transition Status Other includes those who lost Medi-Cal eligibility, moved out of the state, etc

Sustainability Planning HCBS Advisory Workgroup to identify and adapt the best practices in CCT. Statewide training on person-centered counseling. Less-burdensome authorization and payment structures that allow providers to meet immediate needs of Participants, in real time. Improved cross-discipline collaboration. Expanded flexibility in HCBS waivers for coverage of tenancy-based support services. We intend to continue to work with stakeholders to identify and adapt the best practices identified in the MFP Rebalancing Demonstration for inclusion in future Medicaid HCBS waiver renewals and amendments. To date, stakeholders have expressed interest in the following: Statewide training on person-centered counseling Greater flexibility in household set-up reimbursement Less-burdensome authorization and payment structures that allow providers to meet immediate needs of Participants, in real time Improved cross-discipline collaboration Expanded flexibility in HCBS waivers for coverage of tenancy-based support services California remains committed to providing long-term services and supports to Medi-Cal members in the least restrictive setting of their choice through the oversight and guidance provided by the State’s Olmstead Advisory Committee, ADRC Stakeholder Committee, California’s HCBS waivers, and the Medicaid Health Home State Plan Option. Finally, as one of the leading states in demonstrating the value of managed care delivery systems in providing cost-effective coverage for its Medicaid population, California has shown that managed care is a viable option for members of all ages and health conditions. Currently, over 80% of all Medi-Cal members are enrolled in managed care and momentum is growing as managed care plans become more aware of the HCBS available to their members through community-based organizations providing valuable services outside of the acute care medical network. California’s Medicaid Health Home State Plan Option is intended to provide supplemental services that coordinate the full range of physical health, behavioral health, and community-based LTSS needed by beneficiaries with chronic conditions.  

Home and Community-based (HCB) alternatives waiver Nursing Facility / Acute Hospital (NF/AH) Waiver Renewal Home and Community-based (HCB) alternatives waiver

Home and Community Based (HCB) Alternatives Waiver Renewal of the former Nursing Facility/Acute Hospital Waiver Key Changes Increase in waiver size Will provide additional slots for the current and potential future needs Increase in cost caps The waiver will be shifting from an individual cost limit to an aggregated cost limit across the entire waiver. In other words, individuals will no longer be assigned a specific cost cap

HCB Alternatives Waiver (continued) Key changes continued Localizing waiver administration The state will be contracting with waiver agencies (WAs) to perform waiver administration These agencies will be responsible for providing case/care management or contracting out for this service See handouts for additional information

Questions? Karli.Holkko@dhcs.ca.gov