The San Diego County Board of Supervisors on May 19 approved expanding a pilot program that allows funding for homeless social work services to come from the state’s low-income health insurance program, Medi-Cal.
That’s because the California Advancing and Innovating Medi-Cal (CalAIM) initiative is changing how healthcare is viewed, as something more than just a trip to the doctor’s office.
Historically, local governments have paid for homeless case management services, largely with local taxpayer money. And healthcare providers bear the medical costs down the line, including emergency room visits.
“Under this new system, our county's homeless outreach team can actually bill (Medi-Cal) for the work that we are already doing,” Board Vice Chair Monica Montgomery Steppe said before the vote. “Housing navigation, case management, and getting people off the streets and into stable housing.”
Montgomery Steppe said in 2027, the county projects this initiative will fund 78% of the work from the Office of Homeless Solutions (OHS). About 90% of OHS clients are Medi-Cal eligible.
OHS will still provide services for people who aren’t eligible by continuing to use county funds. Those services involve helping people find a place to live, keeping them housed and assisting with the cost of moving.
“I think it's super important that we are looking at all the potential funding that we can bring down, from all levels of state to taxpayers, local taxpayers,” OHS Director Dijana Beck said. “And primarily serve the people that have these needs and expand those services so that they can access in a way that they're eligible for.”
San Diego County had a consultant analyze programs to see which aligned with the goals of CalAIM, and Beck said they identified the services from OHS’s case management team. But she said the county is continuing to explore additional ways to utilize the initiative.
CalAIM is a reform effort by the California Department of Health Care Services to expand access to a wider range of care.
“It's really designed to expand what Medi-Cal covers beyond just the visit with your physician to also encompass social supports to address more health equity and whole-person needs,” said the county’s Medical Care Services Director Jamie Beam.
Utilizing CalAIM to bill Medi-Cal began as a pilot program in March, starting with four employees, and is now expanding to the entire OHS case management team of 35.
Growing this program is part of a larger county effort to explore cost-saving opportunities before considering service cuts. At last week’s county board meeting, Supervisor Paloma Aguirre advised her fellow board members to evaluate the initiative’s success beyond finances.
“A year from now, we should be able to see whether this model improved housing placements, service engagement, emergency room utilization and reduced recidivism rates,” she said.
Beck said the money saved through this program will go back into general funds and be reallocated through county budgeting processes.
She said their goal is to have the program established by the beginning of 2027. At the end of 2027, Beck said the program should be fully up and running, serving about 800 households on any given day.
