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Marin organizations obtain $2.7 million in Medi-Cal funds

The group that coordinates the advantages of Medi-Cal beneficiaries in Marin has awarded greater than $2.7 million in state grant funds to native entities as a part of an effort to reshape the Medi-Cal system.

Since 2011, Fairfield-based Partnership HealthPlan of California has managed well being look after Marin residents who qualify for Medi-Cal. There are 48,000 recipients within the county.

The state pays the Partnership a certain quantity per affected person every year, and the Partnership assigns every of its Medi-Cal sufferers to a main care doctor in Marin. The aim is to offer Medi-Cal beneficiaries with constant main well being care and preventive care to maintain them wholesome and out of hospital emergency rooms, the costliest place to obtain therapy.

Underneath the brand new plan, known as California Advancing and Innovating Medi-Cal, Medi-Cal will fund extra proactive interventions. The affiliation will probably be chargeable for paying group organizations to offer non-clinical companies that acknowledge the social determinants of well being, reminiscent of entry to housing and wholesome consuming.

The affiliation will probably be required to reimburse organizations to carefully monitor the care of sure susceptible recipients by assigning them an “enhanced care supervisor.”

The group is receiving further cash from the state to pay for improved case administration, however no further cash to offer extra group assist, which is predicted to end in price financial savings.

“It is thrilling,” mentioned Liz Gibboney, govt director of the Partnership, “as a result of it is a recognition by the state and the Medi-Cal program that well being and well-being usually are not solely decided by the standard of well being care an individual receives particular person, but in addition for his or her social wants as nicely”.

A complete of $1.5 billion in state cash throughout fiscal years 2021-22 by means of 2023-24 has been allotted to managed care organizations just like the Partnership to allow them to present incentive funds to group organizations to accommodate this variation.

Up to now, the Partnership has awarded greater than $1 million to Marin Neighborhood Clinics, $584,567 to the Ritter Heart, $417,498 to Marin Metropolis Well being and Wellness Heart, $362,116 to Neighborhood Motion Marin, and $325,000 to Homeward Certain of Marin.

“The state sees this as infrastructure and capability constructing,” Gibboney mentioned. “The cash might be spent on issues like hiring workers, creating information programs, shopping for software program and {hardware}. Issues that make it simple to work with managed care plans just like the Partnership and get the info the state is in search of.”

Mitesh Popat, govt director of Marin Neighborhood Clinics, mentioned the federally certified well being middle, the most important within the county, will spend most of its allocation, about $500,000, to transform it to an OCHIN Epic digital well being file system.

“Many of the hospitals and specialists in the neighborhood are already on Epic,” Popat mentioned.

Marin Neighborhood Clinics may also spend $467,000 to extend its housing navigation companies and assist sufferers keep in or discover housing. It is going to spend $91,000 to offer higher case administration for sufferers.

“MCC has been concerned in these kind of efforts for just a few years,” Popat mentioned, “however the cash will assist us enhance staffing in these areas.”

Mark Shotwell, govt director of the Ritter Heart, mentioned his nonprofit will use a part of its allocation to offer higher case administration for Medi-Cal beneficiaries who qualify for the additional profit. The remainder of the cash will probably be used to implement the identical OCHIN Epic system because the Marin Neighborhood Clinics.

“Improved case administration permits us to proceed to offer the companies that have been funded by Entire Individual Care,” Shotwell mentioned, referring to a county pilot program.

This system, which acquired federal Medicaid funding by means of the top of 2021, supplied case administration for these with delicate to average psychological well being points.

Gary Naja-Riese, a county homeless officer, mentioned the county continues to fund everlasting supportive housing case administration.

Harold Wallace, govt director of the Marin Metropolis Well being and Wellness Heart, mentioned his federally certified well being middle will use its allocation to extend its case administration companies for top customers and Medi-Cal sufferers with medical situations. critical psychological.

Wallace mentioned the middle is seeing seven sufferers and the Partnership has referred one other 23 sufferers. The middle employs a case administration director and a case supervisor and plans to rent two extra care managers. Wallace hopes that finally every case supervisor will oversee about 20 sufferers.

Wallace mentioned improved case administration has the potential to avoid wasting the state cash by decreasing the variety of appointments sufferers miss and guaranteeing sufferers observe the complete course of remedy.

“The secret is that sufferers should comply with take part in this system,” he mentioned.

Solely sure Medi-Cal sufferers will probably be eligible for enhanced administration companies. They embody, however usually are not restricted to, the homeless; excessive customers of avoidable emergency division, hospital, or short-term expert nursing facility companies; and adults with critical psychological sickness or substance use issues.

Chandra Alexandre, govt director of Neighborhood Motion Marin, mentioned the modifications underway will permit her group to invoice the Partnership for the work it is already doing: offering housing navigation and housing deposits to low-income residents. She mentioned that she is going to use the cash she is receiving to rent a billing specialist and repair coordinator.

“California is on the forefront of understanding the essential intersection between public well being and the supply of social companies,” mentioned Alexandre. “By supporting our means to do our jobs higher and extra successfully, the state will obtain higher outcomes for individuals.”

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