A bill on Gov. Gavin Newsom’s desk would direct the state to study the feasibility of adding services like in-home care for older or disabled Californians to the list of required benefits in Medi-Cal.
Right now, it is optional for Medi-Cal providers to offer community services that help people stay at home or in an assisted-living facility instead of a nursing home.
Hagar Dickman, director of California long-term services and supports advocacy for the nonprofit Justice in Aging, noted one of those providers, Health Net, announced last month it will drop assisted-living benefits in certain counties on Jan. 1, 2027.
“They decided that they no longer want to provide it – that it is cheaper for them to have people going in and out of hospitals and long-term care stays than to have people stably housed in assisted living,” Dickman said.
Health Net is eliminating services that help cover thousands of Medi-Cal patients’ assisted-living costs, as well as some in-home care services.
California’s Medi-Cal program does pay for care in assisted-living facilities outside of managed care through the Assisted Living Waiver program, but there are 18,000 people on the waiting list.
Mariya Kalina, executive director of the California Collaborative for Long Term Services and Supports, described this development as a symptom of a much larger problem.
“We don’t incentivize home and community-based services the same way that we do with facility-based care,” Kalina pointed out. “It would be great to see them become covered through Medicaid.”
Research shows cutting back on services that keep people in their homes as they age can push them into more expensive forms of care. A study from the California Healthcare Foundation found that a 10% cut to five Medi-Cal home- and community-based service programs would end up costing the state $57 million in the first year, and more than $1 billion in the five years after that.
