Two years in the past, Gov. Gavin Newsom’s administration unveiled a brand new plan to assist clear up the homelessness disaster: It started utilizing well being care suppliers, funded via Medi-Cal, to assist folks get and keep housed.
Now, with President-Elect Donald Trump about to take workplace, some well being care organizations, homeless service suppliers and different stakeholders all through California fear this system might crumble simply because it’s beginning to make a distinction. It’s one among many potential shake ups they’re bracing for as they put together for a brand new federal administration unlikely to see eye to eye with the Golden State on lots of its social welfare insurance policies.
“It makes us all very nervous,” mentioned John Baackes, outgoing CEO of Medi-Cal supplier L.A. Care Well being Plan.
CalAIM, launched in 2022, is an growth of Medi-Cal that enables medical insurance to pay for sure issues that aren’t thought-about conventional medical care — similar to providers to assist homeless Californians discover and maintain housing. Proponents say it’s introduced a much-needed infusion of cash into the state’s overburdened homeless providers system.
However as a result of states aren’t sometimes allowed to spend Medicaid {dollars} on these varieties of providers, California needed to get particular permission from the federal authorities. That permission, within the type of two waivers, expires on the finish of 2026.
Which means the destiny of CalAIM rests within the arms of the Trump administration, which might determine whether or not to resume this system, scale it again or change it. Trump has but to offer any indication of what he would do (and even whether or not this particular California program is on his radar) and most stakeholders agree any adjustments he makes most likely wouldn’t come till 2026. However the uncertainty is compounding the stress on already overburdened homeless service suppliers, who routinely obtain short-term, one-time grants as a substitute of everlasting funding, making it tough to plan for the long run.
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“CalAIM has been one of the most important and, I think, under-appreciated policies of the Newsom administration, to try to better connect our health system and our housing system,” mentioned Tommy Newman, vp of public affairs for United Approach of Better Los Angeles. “And the risk of going backwards on that is scary.”
Newsom’s administration wouldn’t specify what, if something, it’s doing to safeguard CalAIM.
“California will continue to work collaboratively with our federal partners to ensure that families in our state are healthy and our communities are vibrant places to live and work,” Anthony Cava, spokesperson for the Division of Well being Care Companies, mentioned in a press release. “While we don’t typically speculate on the potential impacts of a new federal administration, we remain committed to protecting Californian’s access to the critical services and programs they need.”
What’s CalAIM?
The purpose of CalAIM is to handle elements generally known as “social determinants of health” for low-income Californians. It’s arduous to remain wholesome if you don’t have entry to fundamental requirements, similar to housing and nutritious meals, for instance. In the end, it’s supposed to save lots of the state and the feds cash by serving to folks keep away from costly emergency room visits.
In 2023, greater than 68,600 Californians used the three providers generally known as the “housing trio” below CalAIM. These are providers designed to assist them discover housing, keep housed or pay for move-in prices similar to safety deposits and first and final month’s lease, in accordance with the newest state information obtainable. Solely CalAIM’s “medically tailored meals” service (which helps folks with situations similar to diabetes entry meals that meets their dietary wants) was almost as standard, with almost 62,700 customers.
CalAIM supplies a complete of 14 of those providers, or “community supports,” which additionally embrace medical respite take care of individuals who not too long ago left the hospital, bronchial asthma remediation — assume air filters, dehumidifiers, mould removing — and sobering facilities. CalAIM additionally supplies one thing known as “enhanced care management,” which pairs Medi-Cal members with an intensive case supervisor who can assist them entry the whole lot from a health care provider to a dentist to a social employee.
One-time grants, doled out to well being plans as an incentive for them to ramp up CalAIM providers, additionally helped fund the development of latest reasonably priced housing.
Abode Companies, a nonprofit that gives shelter, housing and different support for unhoused folks throughout seven Bay Space counties, serves greater than 1,000 Californians via CalAIM, mentioned CEO Vivian Wan. In Napa County, Abode makes use of CalAIM to supply case administration providers to assist folks transfer from homeless encampments into shelter and housing. In Santa Cruz County, Abode makes use of CalAIM funds to switch the federal COVID-19 homelessness funds that poured in throughout the pandemic however have since dried up.
Abode and different nonprofits additionally use CalAIM funds to fill an vital hole usually left by different grants: providers for previously homeless folks dwelling in backed housing. State packages similar to Homekey supply cash to purchase or construct homeless housing, and vouchers pay for tenants’ lease, however there’s usually nothing left to fund the case administration, counseling and extra that’s essential to assist folks with bodily and psychological well being situations, or addictions — the folks Newsom has made a precedence in his effort to clear encampments — maintain onto their housing.
“I shudder to think what would happen if we had all of the mandates from our development side of supporting people through coordinated entry, taking really vulnerable people, and we then reduced the services down to bare bones,” Wan mentioned.
What would Trump do to CalAIM?
It’s tough to invest about what the Trump administration will do with CalAIM. Celeb doctor Dr. Mehmet Oz, Trump’s choose to run the Facilities for Medicare & Medicaid Companies, has no prior expertise with the company and due to this fact no observe file that might present clues as to how he’ll act.
Any adjustments seemingly can be felt on the finish of 2026, when California makes an attempt to resume its CalAIM waivers. Nevertheless it’s not unprecedented for a president to terminate a waiver early. After President Joe Biden took workplace in 2021, he pulled waivers, licensed by Trump, that had allowed states to require Medicaid recipients to show they had been working or unable to work. However that was an excessive scenario, as a number of courts had already shot down these waivers.
“It’s not like CalAIM is going away tomorrow, or even in January,” mentioned Sharon Rapport, director of California state coverage for the Company for Supportive Housing. “But after that, I think that’s where the questions are: What could happen then? And the fact that it’s California, and not Trump’s favorite state, I think makes people worried.”
Plans to develop future protection additionally could possibly be in danger. Well being plans are rolling out new frameworks below CalAIM to supply well being care to folks in jail and jail as much as 90 days earlier than they’re launched. California additionally has utilized to amend one among its federal waivers so as to add rental help to the providers CalAIM presents. If that’s accredited, the state can be allowed to make use of Medi-Cal to pay for as much as six months of lease for homeless and at-risk people who find themselves leaving settings similar to jail, jail, the hospital, or an in-patient psychological well being or substance abuse facility.
However a latest article by conservative assume tank the Manhattan Institute questions using well being care funds to pay for social providers — a possible bellwether that means the brand new administration may not be supportive of packages like CalAIM.
“Even if a social welfare program is a well-intentioned and wise idea, that does not make it health-care,” wrote Manhattan Institute senior fellow Chris Pope. “Health care costs will not be greatly reduced by expanding the meaning of health care to cover every social service; nor would doing so distribute nonmedical assistance to those who need it most.”
The Trump administration additionally may change the waivers earlier than renewing them, forcing California to pare down the providers CalAIM presents, or add work necessities.
Trump, in addition to the Republican-controlled Congress, are prone to assist requiring Medicaid recipients to show they’re both working or are unable to work. The final time he was in workplace, Trump accredited 13 state waivers that included work necessities, earlier than the Biden administration later withdrew them. Mission 2025, a conservative governing blueprint written by the Heritage Basis, additionally prioritizes work necessities.
Work necessities traditionally result in folks, particularly low-income folks and folks of colour, shedding advantages, in accordance with analysis by the progressive assume tank Heart on Price range and Coverage Priorities. It discovered many recipients are working however have a tough time offering the required paperwork to show it, whereas others can’t work resulting from obligations as full-time caregivers or an absence of kid care.
Trump and Congress additionally may impose extra sweeping cuts to Medicaid as an entire, which may have an effect on California’s capacity to proceed packages similar to CalAIM.
There are methods California may safeguard at the very least a few of its CalAIM providers, by baking them into Medi-Cal as everlasting advantages, Rapport mentioned. Her group is pushing for the state to try this with CalAIM’s three housing providers.
Employees at L.A. Care already are fascinated with how they may proceed providing CalAIM providers to their members if the Trump administration cuts this system. It might require some vital rearranging of funds, mentioned Chief Medical Officer Dr. Sameer Amin. His group has almost 16,800 folks enrolled in CalAIM providers to assist them discover and maintain housing.
“My concern is that the housing crisis in LA County is not something that happened overnight, and it’s not something that can be corrected overnight,” he mentioned. “It really requires a sustained effort over the course of years and a significant amount of investment. And if we don’t do the investment that we need to do, if we have to reprioritize away from some of these programs, my concern is that these folks are not going to get the health care that they need because they are not housed.”
Employees author Kristen Hwang contributed to this story.
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