Building Medicaid data readiness for California human services providers

Elizabeth Goodman
August 24, 2023

Photo by Jim Kennedy. Some rights reserved.

🗞 California has approved A1M to provide unified policy, design, and digital transformation consulting for community-based organizations.

California’s CalAIM initiative redefines health care as more than “going to the doctor.” Taking a whole-person approach to human well-being, it seeks to weave together traditional medical care, behavioral health, and home health care with social services such as housing and food. The program is ambitious, bridging federal Medicaid oversight, state programs, managed care insurance plans, and local services. It’s a path towards more wrap-around care for Medi-Cal members who might otherwise fall through the cracks. For service providers, it might be a financial lifeline in an age of budget cutbacks.

Two herons in a tree look at a faraway nest that is unattended.

Changing back office and client services will require human-centered culture change.

Redefining “health” to include housing, food, and transportation is not just a back office billing upgrade.

For service providers new to healthcare, entering the Medi-Cal ecosystem floods them with unfamiliar language and requirements. With each Medicaid plan handling its own outreach and communications processes separately, leading to divergent enrollment experiences across plans. To finish enrolling, providers need to comply with federal and state data requirements, from HIPAA compliance to a new state-wide data exchange framework. One of our clients, the director of a rural community-based organization, told us: "It’s been a challenge for us to put together all the different pieces to apply to become a CalAIM Community Supports provider, even with my prior clinical experience with Medi-Cal!"

Redefining “health” to include housing, food, and transportation is not just a back office billing upgrade. It entails redesigning services and workflows from first encounters to referrals. It means hiring new staff, upgrading equipment, and training frontline employees to follow the new rules. Rural community-based organizations face some of the biggest challenges, since their counties frequently have fewer resources available to help them than urban ones. Some feel that they can only watch as urban organizations move ahead.

One heron works to build a nest while another moves in the opposite direction.

With consulting services at no cost to participating organizations, California has committed to equity for counties with less resources.

“Technical assistance” doesn’t just mean “ask the help desk.”

In response, California has dedicated $1.85 billion to technical assistance for service providers who are serious about CalAIM but need help building Medi-Cal-ready staffing and infrastructure. A wide range of organizations are eligible for help beyond community-based organizations, including county and city agencies, Federally Qualified Health Centers (FQHC), and tribal entities. It pays for consulting in domains ranging from data management to workforce development. That's part of how we can help. Beyond our own assistance, we connect clients, like that community organization, to other sources of support.

In this case, “technical assistance” doesn’t just mean “ask the help desk.” “Assistance” means both strategic and tactical support, from service and process redesign and procurement help to making usability improvements. Moreover, we believe that the assistance cannot also stay just “technical." Our experience is that changing back office and client services demands human-centered, participatory culture change.

A1M is now an approved vendor for Domain 1: Building Data Capacity: Data Collection, Management, Sharing, and Use. Organizations working with, or even just considering, CalAIM can get unified policy and digital technology support from us to ready their operational processes and organizational cultures for Medi-Cal participation.

The heron that was moving away has returned to help the first bird build its nest.

We’re currently looking for partner organizations to transform California health care with us.

Learn more about the program and how to apply for assistance here.
Or email us at sales@a1msolutions.com for a walk through the process.

We’re always happy to talk.

All photos by Jim Kennedy. Some rights reserved.

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