Medicaid patients remain in acute care settings (acute hospitals, long term acute care hospitals, skilled nursing facilities) because there are no safe, clinically appropriate discharge options. This results in an increased number of administrative or denied days because the patients are no longer clinically acute and are just awaiting placement. Patients who could be in an inpatient bed or in a skilled nursing facility are instead stuck boarding in the emergency department or an inpatient bed. This leads to crowding both in the emergency department and the inpatient setting, which is both bad for the patient and costly for the health care system.

Enhanced Care Management (ECM) and Community Supports (CS), as offered through California Advancing and Innovating Medicaid (CalAIM), can address this problem by increasing the number of safe, clinically appropriate discharge options. The challenge is weaving the discrete benefits and funding streams offered under CalAIM into a system of care that augments the existing discharge options.

This project focuses on the implementation of CalAIM Community Supports by translating CalAIM’s vision into a concrete approach through nontraditional partnerships. The project expands the capacity of existing service providers (personal care services providers, shelters, recuperative care/medical respite, transitional housing, sober living environments, board and cares, assisted living facilities, residential care facilities for the elderly (RCFEs), etc.) through using CalAIM CS to pay for these services and makes them directly accessible to acute care facilities as Medicaid funded discharge options.