It’s my privilege this month to turn over this newsletter to HealthBegins Senior Program Manager Alexis Taylor, who is doing important work at the center of California’s Medicaid transformation, and shares powerful lessons from both her expertise by training and her expertise by experience.
Rishi Manchanda, MD, MPH.
Medicaid is beginning an important transformation to address health-related social needs through a fusion of new benefits and optional policy tools to fund additional services. But in truth, there is nothing optional or additional about this change. It is essential. I know firsthand.
I was in utero when my mother was engulfed by the crack epidemic in South Central Los Angeles. My grandmother, a retired LAUSD teacher and a rock of a Black woman, set about raising my older siblings and me while concurrently trying to save her own daughter’s life. We lived on a fixed income. Food was a luxury—not just healthy meals, but any food at all. We qualified for Medicaid (Medi-Cal in California) but not food stamps. Once my mother managed to recover, she was diagnosed with end-stage renal failure and needed regular dialysis. I also was sick often as a child, suffering from anemia, gastrointestinal problems, and a benign tumor, and undergoing surgeries. Being Medicaid beneficiaries was literally lifesaving for us. But without reliable food to eat, how could my mother or I heal or truly sustain our health?
California is now pioneering partnerships between Medicaid managed care organizations and community-based organizations (CBOs) to provide the kinds of services that would have transformed my family’s well-being those three decades ago, through two new reimbursement streams called Enhanced Care Management (ECM) and Community Supports (CS). These new avenues are part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, also known as Medi-Cal Transformation, which launched in 2021 to improve health outcomes and equity by integrating health and social care for the state’s most marginalized communities—communities with whom I am closely connected.
Two years into this journey, California can serve as a model for Medicaid transformation across the country—and that includes lessons on both successes and solutions to core challenges. As a Senior Program Manager with HealthBegins supporting CalAIM stakeholders, I have seen both. And from this vantage point, I want to share lessons that can make Medicaid transformation efforts across states not only inspirational but effective and equitable.
What’s crystal clear from both my professional and lived experience is that CBOs are critically important to providing whole-person care. They are providers in the full sense of the word, and they bring expertise, impact, and a connection to underserved communities that healthcare institutions typically cannot attain on their own. In my community in South Central LA as a child, we had exactly one CBO, the local YMCA, and we dearly needed more. Now I work with courageous CBO leaders as a facilitator for the PATH CPI Collaboratives— workgroups established to convene CalAIM stakeholders and identify and uplift both challenges and solutions.
Yet the challenges these CBOs have faced in the early stages of CalAIM show that such efforts run a high risk of leaving out and leaving behind the small, local CBOs that know their communities best. As clinical-community partnerships grow, they often strain the very CBOs that they depend on. Even well-meaning policymakers and healthcare partners may end up structuring partnerships in ways that CBOs cannot sustain.
Fortunately, Medi-Cal Transformation in California has given us the opportunity to identify these challenges on the front lines. My journey within CalAIM offers insights that extend beyond California’s borders—an invitation for other states to leverage our lessons as a guiding light of sorts. Our work isn’t just about empowering ECM and CS providers; it’s a testament to what successful Medicaid transformation can achieve. In CalAIM’s first year, social-service providers touched the lives of more than 100,000 members, a remarkable stride towards equity.
I’m honored to share the lessons linked below to help set up partnerships to thrive around the country—with gratitude and admiration to the California healthcare and CBO leaders who are doing the hard, pioneering work to bring them to light.
The social services that CalAIM providers are bringing to Medicaid beneficiaries would have also made a world of difference to me in my twenties, when I was diagnosed with aggressive, life-threatening breast cancer. I was just shy of my 25th birthday. My husband and I had a young son. And I was pregnant with our daughter. Going through chemotherapy and surgery, I couldn’t work, so we couldn’t keep up with rent. We were almost evicted twice. We communicated our situation to our landlords, who didn’t care. We avoided losing our home only by personally going out to find grants, even while sick. Medi-Cal provided our medical insurance, but there was no one to provide the stable housing that’s so crucial to health and healing.
When I think about what CalAIM is creating, I can’t help but think about my own experience. I think about a person with complex needs who now has healthy meals. I think about a person going through cancer who now has transitional housing. These services save lives. When I share my own experiences with colleagues, they’re captivated—and we need to bring that same passion and fervor, and that same connection to the people Medicaid serves, into every conversation about this work.
Medi-Cal Transformation shows us that change is possible when we harness the power of lived experience to inspire a better future for all. Our journey is just beginning, but every lesson learned is a step closer to a more inclusive future. As I often say, CalAIM is on fire, ready to illuminate the path toward equitable and accessible health and social care for all.