Aging in place in your state: California in flux
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California is one of America’s most diverse states, and we’re not just talking about the fact that about 40 percent of the state’s population is Latiné and more than 15 percent of its residents are of Asian descent.
The country’s third-largest state by area is also its largest by population. Because California stretches along a sizable swath of the West Coast, its climate ranges from year-round warmth and sizzling deserts in the south to snowy mountains in the mountain ranges of northern California.
The state’s diversity of diversities are fascinating, but they can be challenging when it comes to helping California seniors stay healthy, active, and living at home for as long as possible. While the state’s aging population has long relied on MediCal and other federal, state, and local programs, those programs are currently in flux as California attempts to reform much of its health care safety net.
The changes to MediCal began rolling out this past January, and indications are that they will have a major impact on how seniors and people with disabilities use health care and other benefits.
Much of this effort is an attempt to catch up with trends already occurring in the health care systems of California and most other states, like the federal Affordable Care Act and changes to various federal and state policies and regulations, according to the state Health and Human Services Agency.
Because of California’s geographic size, large population, and diversity, many attempts to improve or add services for senior and disabled residents have tended to fragment the system, adding layers of complexity that make it difficult for people to navigate the system successfully.
“Depending on the needs of the beneficiary, some may need to access six or more separate delivery systems (managed care, fee-for-service, mental health, substance use disorder, dental, developmental, In Home Supportive Services, etc.),” reads a report released under the names of DCHS acting director Richard Figueroa and California Gov. Gavin Newsom. “As one would expect, need for care coordination increases with greater system fragmentation, greater clinical complexity, and/or decreased patient capacity for coordinating their own care.”
The reforms currently underway, dubbed California Advancing and Innovating Medi-Cal (CalAIM), seek to “meet the behavioral, developmental, physical, and oral health needs of all members in an integrated, patient centered, whole person fashion” by aligning funding for services, improving and streamlining data reporting, improving infrastructure, and improving overall system quality. Specifically, CalAIM has identified three main goals:
Take a “whole person,” holistic approach to identifying and managing the needs of Medi-Cal beneficiaries, one that considers the full spectrum of a person’s medical, emotional, socioeconomic, behavioral and other needs.
Make Medi-Cal “a more consistent and seamless system” by reducing complexity and increasing flexibility.
Improve outcomes and transform the delivery of services “through value-based initiatives, modernization of systems and payment reform.”
It’s not yet clear how all of these changes will affect senior and disabled Californians who need help adapting their homes to help them age in place. However, the state does not plan to contract benefits, even as it streamlines the means of delivery for those services. What seems probable is that California will still offer Medicaid waiver-style “home and community based services” programs, likely including benefits for services like transition from institutional to community living, benefits to help install assistive technologies, and home modifications that help increase safety and preserve independence.
One indicator of this continuation is that, in 2019, Newsom issued an executive order creating a Master Plan for Aging (MPA) to “serve as a blueprint that can be used by state government, local communities, private organizations and philanthropy to build environments that promote an age-friendly California.”
California hopes to fully implement the MPA by 2030, which includes five goals: reimagining health care to optimize both health and quality of life, helping residents make meaningful community connections to combat isolation and neglect, boosting support and resources for caregivers, increasing economic security, and ensuring “Housing for All Ages and Stages.” This last goal aims to help Californians “live where we choose as we age in communities that are age-, disability-, and dementia-friendly,” as well as “climate- and disaster-ready.”
“California has the nation’s largest aging population, the largest population of those living with Alzheimer’s and other dementias, and the largest population of those caregiving for these growing and disproportionately diverse communities,” said Maria Shriver, head of a task force that helped craft the MPA’s goals, in a press release last year. “The Alzheimer’s Task Force was proud to collaborate with the Master Plan on aging in identifying bold and ready-to-implement strategies that will lead the nation on a path forward in addressing our aging population, and it will take comprehensive, nonpartisan leadership to get the results we need today.”
The “Housing for All Ages & Stages” goal includes strengthening community walkability and mass transit, providing accessible outdoor and community spaces within a ten-minute walk or less of all residents, boosting disaster readiness for older adults and people with disabilities, and creating incentives to help promote climate-friendly aging, like promoting low vehicle-miles-traveled neighborhoods (a natural feature of aging neighborhoods).
And, of course, the goal includes several components directly relating to housing:
Energy-saving modifications to aging residents’ homes
Developing more affordable housing options, including revising zoning to support moving to more appropriate housing without losing property tax exemptions, revising zoning to allow more Accessory Dwelling Units and residential care facilities,
Preserving and adapting older housing stock to accommodate aging and disabled residents
Promoting mixed-use development, including in fill-in and redevelopment projects, to increase affordable housing stock
We’ll continue to watch California to see how these lofty goals look in real neighborhoods, and how they affect real people’s lives—and we’ll report back when we know more. Hopefully, the input the creators of the CalAIM and MPA received from ordinary Californians, paired with the work of experts in helping people age well, will result in a retooled MediCal that is a model for the nation.
