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

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.

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 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—ten 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 accessed 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."