CAMRI: California’s Medi-Cal Home & Community Based Services Waivers, Benefits & Eligibility Policies, 2005–2008

Health and long term care services and practices constitute a continuum of care, but one that is highly compartmentalized. These compartments are varyingly defined: sometimes by the setting (e.g., hospital, nursing home), sometimes by the provider (e.g., primary care physician, social worker), sometimes by body system or disease (e.g., dementia, congestive heart failure), or by severity of the conditions (e.g., disability, nursing home certifiable, terminal). Transitions between providers and/or settings are a particularly problematic aspect of compartmentalization. All of these factors contribute to sub-suboptimal delivery system effectiveness. Fragmentation of funding, with Medicare being the primary public payer for acute health care and Medicaid being the predominant public payer for long term care, some times impairs continuity of care for those dually eligible for both programs.