Perspectives: Stalling Care Coordination – California’s Move Backward and the Need for a Blueprint


In this Perspectives, Dr. Chernof discusses California’s 2017-2018 proposed budget and how scaling back on key components of the Coordinated Care Initiative diminishes the state’s progress toward integrated care for high-need, high-cost older adults.

Date Updated: 01/26/2017

Last week, Governor Jerry Brown unveiled California’s proposed 2017-2018 budget that included proposals to scale back the state’s progress toward integrated care for high-need, high-cost older adults. California’s Coordinated Care Initiative (CCI) created a basic – albeit limited – policy framework for creating a more organized and integrated approach to care and support for California’s most vulnerable adults. It also set out aggressive savings targets.

Key elements of CCI include the following items:

  • A substantial Medicare-Medicaid integration pilot
  • Transition of long-term care services to managed care
  • Creation of formal linkages between home care and the medical delivery system
  • Development of a universal assessment to better understand adults with complex care needs
  • An expectation of substantial state savings

The Governor’s Budget dismantles CCI, arguing that it has not produced as much savings as expected, and costs in the In-Home Supportive Services (IHSS) program, in particular, have grown more than anticipated. While some important programs inside CCI are slated to continue, several key elements that foster a true system of care will not. This is a step backward, perpetuating siloed care that is both inefficient and ineffective for people, while failing to fully address cost drivers…

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The California Senate Select Committee on Aging and Long-Term Care released a report with recommendations on how California can transform its long-term care system. Read Dr. Bruce Chernof’s latest Perspectives on three of the report’s recommendations state lawmakers should focus on in the new legislative session.

This policy brief summarizes findings from long-term care financing option research by the Urban Institute and Milliman, Inc., courtesy of Health Affairs.