2022

Medi-Cal’s long-term care services reach only a small portion of seniors, disabled adults


UCLA study predicts increasing need for support, especially as population ages

Two Medi-Cal care programs designed to help seniors and disabled adults avoid being placed in nursing homes serve only a fraction of those presumed to be eligible, according to a study published today by the UCLA Center for Health Policy Research, led by Dr. Ninez Ponce, the UCLA Fielding School of Public Health’s Fred W. and Pamela K. Wasserman professor and chair of the Department of Health Policy and Management

Improving access to and expanding the reach of these long-term support services could keep hundreds of thousands of high-need Californians in their own homes and help the state avoid the high costs associated with skilled nursing facilities, the researchers said.

The study authors found high potential demand across the state for the type of services offered by Medi-Cal’s Multipurpose Senior Services Program, which provides health and social services for people 65 and older who would otherwise require institutional care, and Community-Based Adult Services, which provide professional care at licensed adult day health centers in the community for disabled people and others at risk of institutionalization.

That demand will only grow in coming years, with the need for such services increasing through 2025 and 2030 and into 2050, when people 65 and older are expected to make up some 25% of California’s population, according to the study.

“Supportive programs provided to older adults and adults with disabilities at home and in the community are essential to maintaining physical and mental health,” said Dr. Kathryn Kietzman, director of the center’s Health Equity Program. “As the state continues to implement its Master Plan for Aging, it is critical that gaps in access to long-term services and supports are addressed.”

The researchers also found wide disparities by race and ethnicity, age, and geography in the proportion of people estimated to be eligible and those currently receiving these long-term services and support.

Among the study’s findings:

Unmet demand for long-term support services:

•    Only about 39,000, or 16%, of the roughly 243,400 Medi-Cal recipients estimated to be eligible for Community-Based Adult Services were served by the program in 2020.
•    106,700 people were estimated to be eligible for the Multipurpose Senior Services Program in 2020 — almost 10 times more than the 10,324 people actually served.

Racial and ethnic disparities:

•    Among those estimated to be eligible for Community-Based Adult Services, Black Americans and those who identified as two or more races were among the least likely to be receiving services, at 4% and 5%, respectively.
•    Older Asian and Black adults were among the groups most underserved by the Multipurpose Senior Services Program.

Demand for services across California:

•    All of California’s geographic regions had significantly more people who were potentially eligible for both Community-Based Adult Services and the Multipurpose Senior Services Program than actually used them.
•    Los Angeles County served 38% of those potentially eligible for Community-Based Adult Services in 2020, while other Southern California regions, taken together, served 10%.
•    The lowest rates of participation in Community-Based Adult Services were seen in the Northern and Sierra region (2%) and the San Joaquin Valley (3%).
•    The greatest participation in the Multipurpose Senior Services Program was observed in the Northern and Sierra (65%) and Central Coast (38%) regions.

Until now, no one had thoroughly assessed the unmet demand for these programs by determining how many older adults and adults with disabilities were potentially eligible throughout the state, the researchers said. In general, they noted, most of individuals who are eligible haven’t accesses the programs because they are unaware that they qualify.

“Our hope is that these findings will inform and prioritize the implementation of strategies to increase access to care,” Kietzman said. “Ideally, program planners and providers will find ways to improve communication about available programs, ease pathways to program information and enrollment, and streamline eligibility requirements.”

Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
Read Faculty Profile
Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
Read Faculty Profile
Mangione, C
Carol Mangione
Health Policy and Management
Read Faculty Profile
Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
Read Faculty Profile
Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
Read Faculty Profile
Michael Ong
Michael Ong
Health Policy and Management
Read Faculty Profile
Rosenstock
Linda Rosenstock
Environmental Health Sciences Health Policy and Management
Read Faculty Profile
Patricia Ganz
Patricia Ganz
Health Policy and Management
Read Faculty Profile
Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
Read Faculty Profile
James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
Read Faculty Profile
Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Arlene Fink
Health Policy and Management
Read Faculty Profile
Dr. Xi Zhu
Xi Zhu
Health Policy and Management
Read Faculty Profile
Dr. Thomas Rice
Thomas Rice
Health Policy and Management
Read Faculty Profile
Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
Read Faculty Profile
Leah Vriesman
Leah Vriesman
Health Policy and Management
Read Faculty Profile
Dr. John Lu
Z. John Lu
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
Read Faculty Profile
Burt Cowgill
Burt Cowgill
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
Read Faculty Profile
Gerald Kominski
Gerald Kominski
Health Policy and Management
Read Faculty Profile
Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
Read Faculty Profile