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Publications -- Reports / Studies

Updated: AUGUST 30, 2018

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Across the States:
2018 Profile of Long-Term Services and Supports

AUG 28, 2018 | AARP Public Policy Institute | California data

Published for the past 24 years, Across the States presents comparable state-level and national data from a large number of studies and data sources—including some original analysis not found elsewhere—into a single volume.

Data in the 2018 Profile of Long-Term Services and Supports in California includes:

  • Projected Population Growth in California, by Age Group, 2015-2050
  • Projected Diversity of the Population Ages 65+ in California, by Year
  • California State Profile
    • Population Characteristics
    • Private Pay Costs
    • Medicaid Long Term Services and Supports
    • Family Caregivers
    • Home and Community-Based Services
    • Nursing Facilities


More Than Three-Quarters of Low-Income Older Californian Tenants Are Rent Burdened

AUG 21, 2018 | UCLA Center for Health Policy Research | Health Policy Fact Sheet

In 2016, more that three-quarters of low-income older Californians whose head of household is age 65 or over are "rent burdened," and more than half are "severely rent burdened." The shortage of affordable housing is a pressing issue in California.


The SCAN Foundation Launches Community for Millennial Caregivers

JUL 11, 2018 | The SCAN Foundation

One in three young people in America provide unpaid care to an adult friend or relative --- while pursuing education and career goals, as well as relationships. Have you thought about what that may be like? Do YOU give a care?

The new campaign called Do YOU give a care? establishes a community for the 10 million Millennials who provide support to older family and friends. Check out the videos, graphics, and social channels for caregivers and allies to share their stories and tips.


The Final Report of the California Task Force on Family Caregiving:
Picking Up the Pace of Change for California's Caregivers

JUL 10, 2018 | California Task Force on Family Caregiving | Full Report

Executive Summary

The California Task Force on Family Caregiving (the Task Force) was established through Assembly Concurrent Resolution 38 (ACR 38-Brown) to address the challenges encountered by California’s 4.5 million family caregivers who care for individuals ages 18 and older.1,2   Family caregivers are foundational to California’s long-term services and supports infrastructure, surpassing Medi-Cal in terms of the economic value of their unpaid caregiving contributions.2   However, family caregivers face many challenges in this role, including balancing employment and caregiving, accessing culturally relevant and competent services, paying for supportive services, and attending to their own health and wellbeing.

Existing policies in California to support caregivers have not kept pace with changing needs. The recommendations described in this report are intended to bridge the gap between existing policies and the challenges faced by California’s caregivers. After a two-year process and careful consideration, the Task Force is submitting the following recommendations to the legislature.

  • Recommendation 1: Support the financial wellbeing of family caregivers, and limit the extent to which this role contributes to an increased risk of poverty and long-term financial insecurity.
  • Recommendation 2: Modernize and standardize caregiver assessments across the state to increase knowledge of who among caregivers in the state uses services, support individualization of services, and reduce service fragmentation.
  • Recommendation 3: Equip caregivers with easily accessible information, education, and training that is specific to their situation, and is provided in culturally competent and relevant ways.
  • Recommendation 4: Increase access to affordable caregiver services and supports, including respite care that allows caregivers to take a break.
  • Recommendation 5: Integrate family caregivers into hospital processes, support them in navigating care transitions and with providing complex care tasks, and increase caregiver choice in whether to complete complex care tasks.
  • Recommendation 6: Increase funding to California’s Caregiver Resource Centers to expand services, including respite care and educational programs, and support innovative programs.
  • Recommendation 7: Create a statewide advisory council on matters affecting family caregivers that provides advice on integrating caregiver issues across state departments, services, initiatives, and programs, and provides policy expertise to the legislature.

The California Task Force on Family Caregiving urges the legislature to act on these recommendations and sub-recommendations as soon as possible to better support the state’s family caregivers. Gradual and incremental change will result in missed opportunities to help caregivers preserve their health and financial wellbeing.


1. Assembly Concurrent Resolution, Cal. Assemb. B 38 (2014-2015),
Chapter 200 (Cal. Stat. 2015)

2. Reinhard, S. C., Feinberg, L. F., Choula, R., & Houser, A. (2015).
Valuing the invaluable: 2015 update. Insight on the Issues, 104.
Retrieved online at:


New Advocacy Guide: Oral Health for Older Adults in California

JUN 19, 2018 | Justice in Aging | Oral Health for Older Adults in California

Oral health affects overall health – this is particularly true for older adults. Yet, access to oral health treatment is limited and complicated by factors such as lack of dental coverage, complicated rules, and lack of dental providers. To assist California advocates in connecting their clients with oral health treatment, Justice in Aging has developed an Advocacy Guide for Oral Health for Older Adults in California.

The Guide includes a summary with advocacy tips on the following topics:

  • Why oral health matters
  • The state of oral health for older adults in California today
  • Health insurance coverage options for older adults including Medicare, Denti-Cal, and other forms of coverage
  • Unique barriers sub-populations of older adults encounter in accessing oral health including dual eligibles and nursing facility residents
  • Treatment alternatives for individuals without dental coverage
  • Additional resources

It is our intention that this Guide will help advocates navigate the system and empower them to identify and address systemic barriers to care.

Visit Justice in Aging’s Oral Health page for additional resources and help us celebrate #OralHealthMonth by forwarding this resource to your networks.


Narrowing the Gap on Palliative Care in California

JUN 12, 2018 | California Health Care Foundation | Publication & Interactive Maps

When it comes to availability of specialty palliative care, a CHCF mapping project finds substantial progress in the number of programs and the number of people being served in California compared to four years ago.

In 2014, CHCF assessed the supply of specialty palliative care programs compared to the estimated need for people in the final year of life. That research found these services could meet just a quarter to half of the estimated need, with uneven distribution across the state.

This new update finds dramatic increases in the number of palliative care programs and the number of patients served, and broader availability of programs statewide. Inpatient palliative care capacity for the entire state is now estimated to be sufficient to meet 43% to 66% of need, while community-based capacity is estimated to be sufficient to meet between 33% to 51% of need.


PERSPECTIVES: Accounting for Geographic Variation in Social Security Disability Program Participation

JUN 2018 | Social Security Administration | Study

The Social Security Administration (SSA) has released a new study examining why participation rates in disability programs like Social Security Disability Insurance (SSDI) and Supplemental Security Insurance (SSI) vary based on where people live. The study finds that different rates of SSDI and SSI participation can be explained by differences in how prevalent disabilities are in a particular area, as well as by socioeconomic factors. Importantly, the study explicitly refutes the idea that inconsistent administration of these programs (such as differences in allowance and denial rates, or among disability examiners) is the cause of the variation. Arguments about inconsistent administration have been used to incorrectly imply that certain areas of the country are unjustly receiving a disproportionate level of benefits, or the people in those areas are not actually deserving of benefits.

These findings also support previous research by the Center on Budget and Policy Priorities and other experts showing the correlation between health and socioeconomic factors such as wealth and education. People with higher socioeconomic status have better health and longevity outcomes.


Promoting Better Health Beyond Health Care: Report and Case Studies

MAY 2018 | Center for Health Care Strategies (CHCS) | Report :: Case Studies

Cross-sector partnerships are emerging across the country as state officials recognize that health outcomes are influenced not only by access to health care coverage and services, but also by state policies and programs in other sectors, such as transportation and education.

Promoting Better Health Beyond Health Care, a national analysis developed by CHCS with support from the Robert Wood Johnson Foundation, explores opportunities to catalyze state multi-sector collaboration to achieve population health goals. It uncovers opportunities for states to empower local communities, facilitate cross-sector learning, support data-sharing, and cultivate leadership.

In addition, companion case studies highlight successful cross-agency partnerships in California, Louisiana, Massachusetts, Ohio, and Oregon that provide valuable insights on how state-level, cross-sector collaborations can positively impact health outcomes. The report findings and case studies can help guide state efforts to advance multi-sector collaboration aimed at improving population health in transformative ways.


Coordinating Care for Duals Through Cal MediConnect

MAY 9, 2018 | University of California, San Francisco and Berkeley

A new evaluation of the Cal MediConnect program has been released, Coordinating Care for Duals Through Cal MediConnect. The report summarizes how care coordination is implemented, successes with the benefit, and the challenges. It includes eleven recommendations to improve the delivery and effectiveness of care coordination.


Report Finds Untreated Tooth Decay is Hidden Epidemic Among Older Adults

MAR 30, 2018 | BusinessWire | Fact Sheet | Full Report

A new report by the Center for Oral Health (COH) found that a significant number of older Californians are plagued by oral health problems despite the fact that dental disease is largely preventable. The study, “A Healthy Smile Never Gets Old: A California Report on the Oral Health of Older Adults,” found that, overall, one in three older adults need treatment for a decayed tooth, and untreated tooth decay is leading to a high prevalence of tooth loss.

“Research clearly demonstrates that properly addressing dental problems prevents various medical complications and reduces overall healthcare spending,” noted Dr. Sahiti Bhaskara, Director of Public Policy Research, Center for Oral Health. “However, in contrast to the growing awareness about children’s oral health needs, the oral health of older adults has received relatively little attention and few public health or policy interventions. This report is designed to shed light on older adults’ oral health and what can be done to improve health outcomes.”

Key findings include:

  • Half the older adults residing in skilled nursing homes have untreated tooth decay
  • One in three older adults in skilled nursing homes have lost all their teeth
  • Sixty-five percent (65%) of older adults in nursing homes and 46% of community-dwelling older adults need treatment for tooth decay or gum disease
  • Nearly 40% of skilled nursing home residents cannot chew due to poor contact between teeth
  • Older adults in rural areas are 10% more likely to have untreated tooth decay than their urban counterparts

The report outlined recommendations to eliminate barriers to care and improve oral health. These include steps to break down health care silos, prioritize access to care and preventive services in Medi-Cal, expand use of innovative practices, and pursue education programs and outreach.

Data for this report was collected through oral health screenings of 2,372 older adults in California – conducted at 36 skilled nursing homes and 51 community sites that included congregate meal sites, adult day care centers and senior centers.

The Center for Oral Health is a California non-profit dedicated to improving oral health, especially of vulnerable populations, through innovation, research, education and advocacy. This project was funded in part by Archstone Foundation, the California Wellness Foundation, Delta Dental Health Education and Research Fund, and Liberty Dental Plan Foundation.


Mental Health in California: For Too Many, Care Not There

MAR 28, 2018 | Wendy Holt, California Health Care Foundation
Key Findings | Full Report | Quick Reference Guide | Charts | Infographic | Painting a Picture | Blog

Federal and state laws mandating parity in coverage of mental and physical illness, together with expansion under the ACA of both Medi-Cal eligibility and scope of mental health services, have made more services available to more Californians. Public and private actors have devoted significant resources to expand access to care, better integrate physical and mental health care, and reduce stigma. Despite these efforts, the incidence of some mental illnesses continues to rise, many Californians still fail to receive treatment for their mental health needs, and many have poor overall health outcomes.

Using the most recent data available, Mental Health in California: For Too Many, Care Not There provides an overview of mental health in California: disease prevalence, suicide rates, supply and use of treatment providers, and mental health in the correctional system. The report also highlights available data on quality of care and mental health care spending.


Community-Based Palliative Care

MAR 28, 2018 | California HealthCare Foundation
Community-Based Palliative Care Web Page

Community-based palliative care (CBPC) is an emerging field that seeks to integrate palliative and serious illness care with local health care systems. This resource center houses materials designed to assist organizations when planning, implementing, or enhancing their CBPC services. There are eight (8) areas to explore:

  1. Key Concepts: Essential information about the need for and prevalence of CBPC
  2. Best Practices: Guidelines to support program development, monitoring, and improvement
  3. Programs: Practical characteristics of existing programs and models
  4. Making the Case: Consideartions for building a business model and demonstrating value
  5. Measures & Outcomes: Sampling of metrics and performance reports
  6. Tools: Tools to help organizeations identify needs and assess impact
  7. Educational Resources: Courses to build the skills of palliative care specialists and generalists
  8. Organizations: Palliative care leadership organizations


2018 Alzheimer's Disease Facts and Figures Report

MAR 20, 2018 | Alzheimer's Association
Report | Infographic | CA Fact Sheet

The Alzheimer's Association has released the 2018 Facts and Figures Report, Infographic and California Fact Sheet. A Special Report on the Financial and Personal Benefits of Early Diagnosis, located on pages 59-66, is the focus of the Alzheimer's Association's one-time California state budget proposal to improve early detection through a public education campaign in partnership with CDA and the AAAs. This June, the CA Department of Public Health will release its early detection toolkit for primary care providers, developed in collaboration with the 10 California Alzheimer's Disease Centers.

Key California Facts:

  • The size of the population affected increased from 630,000 to 650,000 in one year
  • Medi-Cal costs jumped to $3.776 billion annually
  • Cause of death climbed from 5th to 3rd in CA, claiming 15,065 lives


10 Things to Know about Medicaid: Setting the Facts Straight

MAR 12, 2018 | Robin Rudowitz and Rachel Garfield | Kaiser Family Foundation
Issue Brief

Medicaid is the nation’s public health insurance program for people with low income. The Medicaid program covers 1 in 5 low-income Americans, including many with complex and costly needs for care. The vast majority of Medicaid enrollees lack access to other affordable health insurance. Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs. The program is also the principal source of long-term care coverage for Americans. MORE


National Study of Long-Term Care Providers (NSLTCP): Questionnaires, Datasets, and Related Documents

FEB 27, 2108 | Centers for Disease Control and Prevention, National Center for Health Statistics

Reports recently released using 2016 data:


Alzheimer's Association Issues A Guide to Quality Care from the Perspectives of People Living With Dementia

FEB 2018 | Alzheimer's Association

With more than 5 million Americans living with Alzheimer's disease, direct care workers — such as nurse's aides, home health aides, personal and home care aides — provide most of the paid long-term care to older adults living at home or in residential settings. From the perspective of individuals lising with dementia, quality care includes person-centered care techniques that address their unique experiences and needs, which is contract to a "one-size-fits-all" approach.

In this guide, survey data and interviews from individuals living in the early stage of Alzheimer's or with other dementias are used to describe quality dementia care, explore topic areas relative to the dementia experience and share approaches for care providers. As Alzheimer's progresses, individuals living in the early stage will depend on care providers to help preserve their sense of identity, autonomy and quality of life with dementia. This guide provides valuable guidance for people living with the disease, their caregivers, other family members and anyone concerned about providing high quality dementia care.


The Growth of Managed Long-Term Services and Supports Programs: 2017 Update

JAN 29, 2018 | TRUVEN Health Analytics
2017 Update

Executive Summary | The Growth of Managed Long-Term Services and Supports Programs: 2017 Update | MLTSS Prevalence | Populations Served in MLTSS Programs | State Goals for MLTSS Programs | MLTSS Program Benefits and Exclusions | Functional Assessments in MLTSS | MLTSS Network Adequacy Standards | Conclusion | Appendix A: Description of Existing MLTSS Programs as of August 2017

This report contains information which resulted from Contract No. HHSM-500-2010-00026I, between Mathematica Policy Research, Inc. and the Centers for Medicare & Medicaid Services (CMS), under which project Truven Health Analytics was a subcontractor.


Coverage, Access, and Affordability in California: Key ACA Data 2013-2016

JAN 25, 2018 | California Healthcare Foundation

In 2014, CHCF launched ACA 411, an interactive online tool that provided baseline and trend data to help users track the impace of the Affordable Care Act (ACA) on insurance coverage, access to health care, and affordability in California.

As of 2018, CHCF no longer maintains the ACA 411 tool. However, its raw data is now available as an Excel file for download. The file includes approximately 50 indicators around coverage, affordability, and access to care.


Integration of Medicare and Medicaid in California: Provider Perspectives of Cal MediConnect

JAN 2018 | University of California, San Francisco and Berkeley
Research Brief

In 2014, California became one of 13 states to implement a financial and administrative alignment demonstration called the Coordinated Care Initiative (CCI).

In California, existing Medicare and Medi-Cal (California’s Medicaid program) managed care health plans in seven counties created new products called “Cal MediConnect” (CMC). In demonstration counties, beneficiaries eligible for both Medicare and Medi-Cal, sometimes called “duals,” were passively enrolled into CMC plans, with an option to opt out. Those who were enrolled received all Medicare and Medi-Cal benefits, including both medical services and managed long-term services and supports (LTSS) through a single capitated CMC health plan. CMC plans were also required to provide care coordination services and coordinate behavioral health care.

By September 2017, more than 116,000 dual beneficiaries were enrolled in CMC plans. To deliver these services, CMC plans developed corresponding provider networks, including primary care providers (PCPs), provider groups, Federally qualified health centers (FQHCs), hospitals, and long-term care (LTC) providers. Researchers from University of California conducted an evaluation of the impact of the CMC program on beneficiaries and health systems.

Data collected for this research brief built on Phase I results and included 19 additional interviews with provider stakeholders including physician providers, provider groups, CMC plan directors of provider networks, FQHCs, hospitals, management services organizations (MSOs), and LTC providers. MORE




2017 Med-Cal Quick Reference Guide

California Health Care Foundation (CHCF)
Medi-Cal Facts and Figures: An Evolving Program

Medi-Cal is the main source of health insurance for one in three Californians. This set of materials provides an overview of the program's key features, describes how the program is evolving, and examines the challenges ahead.


Long-Term Care in America: Views on Who Should Bear the Responsibilities and Costs of Care

DEC 2017 | AP-NORC Center
Overview | Report [HTML :: PDF]

The AP-NORC Center’s fifth annual Long-Term Care Poll explores how older Americans feel about the services and support in their community, the country’s preparedness to meet the care needs of an aging population, and other attitudinal trends.

Results from the 2017 Long-Term Care trends poll find that two-thirds of Americans age 40 and older feel the country is not prepared for the rapid growth of the older adult population. The Associated Press-NORC Center for Public Affairs Research survey also finds that at the local level, less than half of older Americans say their community is doing a good job of meeting older adults’ needs for nursing homes, assisted living facilities, and home health care aides to provide long-term care. Additionally, a majority of older adults say they would like the federal government to devote a lot or a great deal of effort this year to helping people with the costs of ongoing living assistance. READ MORE


Millennials and Dementia Caregiving in the United States

DEC 4, 2017 | USC Roybal Institute
Issue Brief | Full Report

Today, the USC Edward R. Roybal Institute on Aging and UsAgainstAlzheimer’s released a issue brief that shows that one out of six millennial caregivers cares for someone with dementia. With the prevalence of Alzheimer’s disease and other dementias expected to reach nearly 16 million in the U.S. by 2050 from 5 million today, more millennials and young Americans are expected to face caregiving responsibilities in the future.

“Caregiving to family members with dementia can be a full-time job. Caring for the millennial caregiver is a societal investment with the potential of delaying family burdens and health care costs in the future,” said María Aranda, associate professor and interim executive director at the USC Edward R. Roybal Institute on Aging.


The Many Faces of Caregivers: A Close-Up Look at Caregiving and Its Impacts
Regional Perspectives: California

NOV 2017 | Transamerica Institute
Survey Report

This national survey of 3,000+ non-professional caregivers examines their duties and the impact caregiving has on their personal health and well-being, employment, finances and retirement preparations. It also offers detailed findings about care recipients, including their health status and financial situation. The survey report comprises these chapters:

  • Primary vs. Non-Primary. This chapter contains a portrait of today’s caregivers based on 26 key indicators measuring caregiving’s impacts on both the caregiver and care recipient.
  • Influences of Demographics on Caregiving. These chapters are demographic segmentation analyses by voluntary status, employment status, gender, generations, household income, and ethnicity. Each chapter presents a concise set of 26 key measures for each demographic segment.
  • Regional Perspectives: California is supplemental report to The Many Faces of Caregivers that compares and contrasts California-based caregivers relative to the national population of caregivers.


Examining Oral Health Care Utilization and Expenditures for Low-Income Adults

NOV 16, 2017 | Center for Health Care Strategies

Access to oral health care for low-income adults is a persistent challenge in the United States. Poor oral health can lead to increased risk for long-term chronic conditions, lost workdays and reduced employability, and preventable dental-related hospital visits for adults enrolled in Medicaid.

To better understand how adult Medicaid beneficiaries are using dental services, the Center for Health Care Strategies (CHCS), with support from the DentaQuest Foundation, analyzed dental service use and cost data for non-elderly Medicaid-enrolled adults by a number of individual-, community-, and state-level factors. The analysis is part of CHCS’ Faces of Medicaid data series, which examines high-cost Medicaid populations to provide stakeholders with important insights to inform program design, service delivery, and cost-effectiveness.


Medicaid and Transportation for Older Adults

OCT 2017 | National Center on Law & Elder Rights
Issue Brief

Non-emergency medical transportation under the Medicaid program is critical for low-income older adults, allowing them to access needed services and age in the community. Delivery of NEMT can be complicated by the various modes of transportation and the different models through which NEMT is administered. Meanwhile, beneficiaries can experience problems with late or absent drivers and with getting the appropriate form of transportation. Advocates must remain vigilant and work with Medicaid plans, brokers, transportation companies, and others to ensure older adults have access to this critical service.

This Issue Brief covers:

  • Why Transportation Matters
  • Medicaid Rules and Regulations Regarding Transportation
  • Types of Transportation
  • Transportation, Dual Eligibles, and Managed Care
  • Recommendations and Troubleshooting Tips for Advocates


Using Medicaid Levers to Support Health Care Partnerships with Community-Based Organizations

OCT 2017 | Center for Health Care Strategies, Inc.
Fact Sheet

This fact sheet outlines strategies to help Medicaid stakeholders encourage partnerships between CBOs and HCOs. States can provide: (1) financial support to build and sustain program capacity; (2) assistance in identifying metrics for evaluation; (3) incentives to providers to address SDOH; and (4) use of policy levers, including value-based contracts, managed care organization regulations, and state plan amendments, to support partnership efforts.


Partnership Assessment Tool for Health (PATH)

OCT 2017 | Center for Health Care Strategies, Inc.

Designed for CBOs and HCOs in existing partnerships, this tool provides a template to understand progress toward benchmarks characteristic of effective partnerships, identify areas for further development, and guide strategic conversation. The objective of the tool is to help partnering organizations work together more effectively and maximize their impact.


Key Issues in Long-Term Services and Supports Quality

OCT 27, 2017 | Charlene Harrington, Joshua M. Wiener, Leslie Ross, and MaryBeth Musumeci
Issue Brief

This issue brief discusses four key issues related to long-term services and supports (LTSS) including institutional and home and community-based services (HCBS) quality, highlighting major legislative and policy changes over the last 30 years. The Appendix Tables provide data about LTSS providers and consumers, summarize key federal laws and policies related to quality, and list selected federal quality measures.


How the Elderly Lose Their Rights

OCT 9, 2017 | The New Yorker | Rachel Aviv

Guardians can sell the assets and control the lives of senior citizens without their consent—and reap a profit from it.


Adult Day Health Care: An Unbelievable Cost Containment Resource that Is Underfunded and Underutilized

Featured Article by Russell D. Foster

For those who think Adult Day Health Care (ADHC) is just day care…think again! Yes, it’s a place for family members to drop-off their aging parents while they head off to work, run errands or simply use the time to get a little (and often much needed) respite from their 24/7 caregiving duties. But, ADHCs are so much more than a place to drop off Mom and Dad for part of a day. MORE


Seniors & the Law: A Guide for Maturing Californians

SEPT 2017 | The State Bar of California

Seniors & the Law — A Guide for Maturing Californians is the third in a series of State Bar consumer education guides and is available in both English and Spanish. The guide addresses a number of issues confronting seniors, including: Finances and debt | Social Security and insurance | Housing and caregiving | Employment | Healthcare | Elder abuse/elder fraud | Grandparents' rights | Divorce and remarriage | Estate planning and legal services.


Tough sell: Frail Angelenos reject managed health program Confusion over new benefits, preference for 'tried and true,' drive opt-outs

SEPT 27, 2017 | UCLA Health Policy | Venetia Lai | 310-794-6963 |
Policy Brief: Cal MediConnect Enrollment: Why Are Dual-Eligible Consumers in Los Angeles County Opting Out?

Three in five of the poorest, sickest residents in Los Angeles County have rejected a managed health care program meant to improve their access to health services, according to a policy brief. As a result, the county’s opt-out rate for the program is the highest in California, pushing overall enrollment far lower than expected.


National Study of Long-Term Care Providers: Study Results and Publications - Presentations

SEP 26, 2107 | 2017 National Adult Day Services Association Conference
Update and What's New from the National Study of Long-Term Care Providers | More Study Results and Publications - Presentations


Supporting People with Dementia and Their Caregivers in the Community

SEPT 14, 2017 | American Society on Aging
Download Publication

The number of people with Alzheimer’s disease, the most common cause of dementia, is projected to increase to 13.8 million by 2050. To help educate about and combat Alzheimer’s, ASA is pleased to introduce a special supplement to Generations, “Supporting People with Dementia and Their Caregivers in the Community.”

The supplement focuses on efforts underway to establish dementia-capable home and community-based service systems, and to develop effective, evidence-based services for people with Alzheimer’s disease and related dementias and their caregivers. The content features research and writing by dementia experts at RTI International, as well as many others well-known in the field of dementia research and advocacy. This content paves the way for service providers, families, and caregivers to provide person-centered, evidence-based, effective home- and community-based service systems for people with dementia and their caregivers.


2017's Best & Worst States for Health Care

AUG 7, 2017 | WalletHub
Main Findings

WalletHub determined that the best state overall for healthcare was Hawaii, which has one of the highest percentages of insured children and adults and the lowest heart disease rate in the country. However, the report notes that the Aloha State also has the lowest rate of physician acceptance of Medicare. Learn where California ranks. . .


Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

JUL 14, 2017 | The Commonwealth Fund
Abstract | Full Report

The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands. Based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries' approaches if it wants to achieve an affordable high-performing health care system that serves all Americans.


Medi-Cal Matters

JUL 12, 2017 | CHCF Newsletter

  • Medi-Cal Matters compiles key facts and figures illustrating the benefits of Medi-Cal coverage to the program's nearly 14 million beneficiaries. Look in the region-specific sections for data on access to care for Medi-Cal enrollees in that area of the state. Download the full chart deck and individual graphics for sharing on social media.
  • Medi-Cal provides a vital safety net to nearly one-quarter of California seniors and half of Californians with disabilities. In total, there are approximately two million seniors and people with disabilities enrolled in Medi-Cal. How many live in your county? How could the Senate’s Better Care Reconciliation Act (BCRA) affect your neighbors? Learn more.
  • The Senate’s BCRA would impose a per-capita cap on federal Medicaid spending. How does the cap work? What would be the impact on Medi-Cal? And what factors might affect these caps over time? Read a new California-specific analysis by Manatt Health.


The Effect of Adult Day Program Attendance on Emergency Room Registrations, Hospital Admissions, and Days in Hospital: A Propensity-Matching Study

JUN 2017 | The Gerontologist, Volume 57, Issue 3, Pages 552–562
Abstract and Full Article | Ronald Kelly, PhD

This study is an investigation of the effect of adult day program attendance by home care clients 65 years of age and older on numbers and rates of emergency room registrations, hospital admissions, and days in hospital.


Medi-Cal Enrollment of Seniors and People with Disabilities, County by County

JUN 29, 2017 | California Health Care Foundation
Medi-Cal Enrollment of Seniors and People with Disabilities, County by County

Today, the Medi-Cal program, California's version of Medicaid, covers nearly 14 million Californians. Approximately two million — or about 15% — are low-income seniors and people with disabilities (SPDs). The number of SPDs enrolled in Medi-Cal varies from 65 in Alpine County to 637,304 in Los Angeles County.


Understanding the Senate’s Better Care Reconciliation Act of 2017 (BCRA):
Key Implications for Medicaid

JUN 28, 2017 | Jocelyn Guyer, April Grady, and Kevin McAvey, Manatt Health
Analysis | BCRA State-by-State Chartbook Cover Memo

Senate leadership has released a proposed substitute for the House-passed American Health Care Act (AHCA) known as the Better Care Reconciliation Act of 2017 (BCRA) that eliminates enhanced funding for Medicaid expansion after a three-year phase out, establishes a cap on federal Medicaid funding for nearly all beneficiaries and services, and makes a number of other changes to Medicaid. Using the Manatt Medicaid Financing Model, this analysis estimates the state-by-state impact of the cap on Medicaid and elimination of enhanced funding for expansion, taking into account that states may respond to the proposed law in a number of different ways. Manatt has also provided a cover memo to explain the data and assumptions.


New Fact Sheet: SSI in California

MAY 26, 2017 | Justice in Aging
SSI Fact Sheet

California has the highest rate of senior poverty in the nation; increasingly more older Californians struggle to make ends meet and stay in their homes, and senior homelessness is on the rise. Over a million California seniors and people with disabilities rely on Supplemental Security Income (SSI) to help them meet their basic needs. There are people who depend on SSI to survive in every community in the state. The majority of SSI recipients are women, are women, and the program is critical for people of color and people with limited English proficiency. It’s also an essential safety net for nearly 300,000 California retired older adults who receive some Social Security, but not enough, because they worked in low-wage or seasonal jobs, or stayed home from work to care for family members.

Please use this new Justice in Aging SSI fact sheet for California that shows who relies on SSI, why it’s important, and the dangers cuts to the program would pose for low-income families and communities.


FACT SHEET: Women and Long-Term Services and Supports

APR 2017 | Ari Houser, AARP Public Policy Institute

Women face major challenges as they seek to live with independence and dignity as they age. With longer average life spans and higher rates of disability and chronic health problems than men, most women will need long-term services and supports (LTSS) in their lifetimes. M O R E


RTI Releases Two Reports Offering an Evaluation of Cal MediConnect

MAR 27, 2017 | RTI

RTI has released two reports this month that offer an evaluation of California's duals demonstration – Cal MediConnect – as well as other demos across the country. RTI will also release its full California-specific evaluation in the next few months.

1. Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans Under the Financial Alignment Initiative | Full Report, MAR 2017

2. Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative | Full Report, MAR 2017

CAADS members may view a brief summary of each report with regard to California-specific findings on the Members Only page. Special thanks to Amber Christ, Senior Staff Attorney with Justice in Aging, for preparing the summary.


Medicaid: A Last Resort for People Needing Long-Term Services and Supports

MAR 13, 2017 | AARP Public Policy Institute


Alzheimer's Disease Facts and Figures - 2017

MAR 10, 2017 | Alzheimer's Association
Report | Infographic


Fact Sheet: Medicare Part D - 2017 Transition Rights

FEB 8, 2017 | Justice in Aging Health Network Alert
Fact Sheet

The Centers for Medicare and Medicaid Services (CMS) requires that sponsors of Medicare Part D prescription drug plans provide beneficiaries with access to transition supplies of needed medications to protect them from disruption and give adequate time to move over to a drug that is on a plan’s formulary (medication list), file a formulary exception request or, particularly for Low Income Subsidy (LIS) recipients, enroll in a different plan.

To assist advocates with transition issues, this fact sheet sets out the CMS minimum requirements for all plans. For further information, contact Georgia Burke,




A Long-Term Outlook: Disability Among California's Seniors

NOV 28, 2016 | California Legislative Analyst's Office

The senior population (adults aged 65 and older) in California is projected to increase more than twofold—from roughly 5 million in 2015 to nearly 12 million in 2060. The demographics of the senior population are also projected to change during this period. For example, the senior population is projected to shift from being majority white to majority nonwhite by 2030. The rapid growth and changing demographics of California’s senior population raise issues about seniors’ long-term supports and services (LTSS) needs, LTSS system capacity, and the financial impact of LTSS on personal and state finances. (LTSS are defined broadly as services and supports provided to the disabled—of any age—who have difficulty performing daily activities.) California-specific projections are necessary to inform the conversation around the future of the LTSS system as California’s senior population grows over the next several decades.

This report, an infographic, and a companion video are available using the following link:


New Atlas on Cost and Quality

AUG 11, 2016 | California Health Care Foundation (CHCF)

Benchmarking and tracking quality and cost measures is critical to reducing unwarranted variation and achieving high-quality, affordable care for all Californians. The new atlas is a collaboration of the Integrated Healthcare Association (IHA), the California Health Care Foundation (CHCF), and the California Health and Human Services (CHHS) Agency, and includes data for nearly two-thirds of Californians. See the new data tool and listen to a discussion.


Medicaid's Role in Meeting Seniors' Long-Term Services and Supports Needs

AUG 2, 2016 | The Henry J. Kaiser Family Foundation

•  How Do Seniors Qualify for Medicaid LTSS?
•  Which LTSS Does Medicaid Cover?
•  How Much Does Medicaid Spend to Cover Seniors' LTSS Needs?
•  What are the Current Policy Issues in LTSS for Seniors?
•  Looking Ahead

Medicare | long-term services and supports (LTSS) | adult day health care | Medicaid | community-based care | Medicaid home and community-based services (HCBS) | Deficit Reduction Act of 2005 | Affordable Care Act (ACA) | risk-based managed care organizations


Women and Poverty in California: We Must Do More

JUN 2016 | California Commission on Aging, the California Women’s Law Center, and the California Commission on the Status of Women and Girls

A new report, Aging, Women and Poverty in California: We Must Do More, written in collaboration by the California Commission on Aging, the California Women’s Law Center, and the California Commission on the Status of Women and Girls, with participation from Justice in Aging, outlines the reasons older women are more likely to live in poverty, describes the impact poverty has on women’s lives, and offers recommendations and action steps to ensure older women can age in dignity.

Additional Resources
How to Prevent and End Homelessness Among Older Adults
The Faces of Senior Poverty are Likely Women of Color


Oral Health in California: What About Older Adults?

JUL 27, 2016 | Justice in Aging Health Network Alert

Oral health is a critical aspect of overall health for people of all ages, but especially for older adults. Unfortunately, the oral health needs of older adults, particularly low-income older adults have been neglected.

A new Issue Brief by Justice in Aging, Oral Health in California: What About Older Adults? explores the reasons why the oral health of older adults in the state is suffering and offers recommendations for improvements.

The issue brief launches a new area of advocacy for Justice in Aging in which we seek to improve oral health for low-income older adults in California.

California ranks 30th in dental care for older adults. Older adults with limited income especially face barriers accessing quality dental care through the state’s Denti-Cal program, which provides dental services under the Medi-Cal program. For example, only one in four California dental providers provide services to Denti-Cal enrollees. Five California counties have no Denti-Cal providers and several other counties have Denti-Cal providers, but they are not accepting new patients. As a result of this and other reasons, older adults in California have high rates of dental decay and tooth loss.

Justice in Aging presented a webinar on this topic on Tuesday, July 26. You can access the webinar slides or watch the video here.

This issue brief and its accompanying webinar was funded by a grant from The California Wellness Foundation (Cal Wellness). Created in 1992 as a private independent foundation, Cal Wellness’ mission is to improve the health of the people of California by making grants for health promotion, wellness, education and disease prevention.


Drop in Percentage of Physicians Participating in Medi-Cal Raises Red Flags

JUL 8, 2016 | Amy Adams, California Health Care Foundation

Physicians' willingness to treat Medi-Cal beneficiaries is critical to ensuring Medi-Cal enrollees have adequate access to care. Without a sufficient number of doctors serving Medi-Cal beneficiaries, Medi-Cal enrollees may not be able to receive care in a timely manner.

Self-reported data from a voluntary survey of California physicians show physician participation in Medi-Cal declined from 69% in 2013 to 63% in 2015. (Physicians are identified as participating in Medi-Cal if they report any of their patients are covered by Medi-Cal.) The percentage of specialty care physicians participating in Medi-Cal likewise dropped during this time, from 70% to 64%. MORE


Special Report: Meeting the Legal Needs of LGBT Seniors

JUN 22, 2016 | Justice in Aging

Legal services organizations play a crucial role in alleviating the effects of poverty for low-income older Americans. However, not all low-income older adults have the same legal needs, not all will seek out help on their own, and for diverse groups, culturally competent service is key to meeting their needs.

How Can Legal Services Better Meet the Needs of Low-Income LGBT Seniors? is a new Special Report by Justice in Aging, produced in partnership with Services and Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders (SAGE). This report explains why LGBT older adults have higher rates of poverty, outlines how discrimination and other factors lead to unique legal needs, and provides practical tips for outreach, intakes, and providing culturally competent legal services to LGBT older adults.


Moving Medi-Cal Forward on the Path to Delivery System Transformation

JUN 21, 2016 | California Health Care Foundation

Today the California Health Care Foundation (CHCF) released Moving Medi-Cal Forward on the Path to Delivery System Transformation. The report, commissioned by CHCF and written by Manatt Health, explores the reforms that are needed to ensure that Medi-Cal consistently delivers excellent access, quality, and patient experience while using resources efficiently.

Manatt conducted a landscape review and in-depth interviews with a diverse array of over 50 Medi-Cal stakeholders and thought leaders. The report assesses key challenges and opportunities in Medi-Cal, establishes a vision for delivery system reform, and articulates a path forward. Topics discussed include capitation rates, behavioral health, workforce shortages, access to providers, and more. See the report.


Special Report: Prevent and End Homelessness Among Older Adults

APR 11, 2016 | Justice in Aging Health Network Alert

More older adults are homeless or at risk of homelessness than at any time in recent history. As the population ages, more adults are aging into poverty. The lack of affordable housing and higher costs for health care and other necessities are also leaving greater numbers of older adults at risk of poverty and homelessness, and systemic economic problems are contributing to the problem. A Special Report by Justice in Aging, How to Prevent and End Homelessness Among Older Adults, created in partnership with The National Alliance to End Homelessness, outlines the problem and recommends policy solutions that can be put in place now to ensure that all older adults have a safe place to age in dignity, with affordable health care, and sufficient income to meet their basic needs.

Read the paper and watch the accompanying video about Bill, a 67 year-old Oakland, CA resident who has struggled with homelessness. Please share the report with others.


California's Uninsured: Coverage Expands, but Millions Left Behind

MAR 22, 2016 | California Health Care Foundation (CHCF)
Report | Infographic

The latest edition of California's Uninsured finds that implementation of the Affordable Care Act (ACA) helped lower the uninsured rate in California from 16% in 2013 to 11% in 2014, but 3.8 million Californians under 65 remained without coverage.

A related infographic shows who gained coverage in California, who remains without it, and why.

Among the key findings from the new report:

  • From 2013 to 2014, the percentage of Californians who had individually purchased insurance or Medi-Cal increased.
  • Californians age 21 to 24 experienced the largest drop of any non-elderly age group in the percentage that was uninsured, from 25% in 2013 to 16% in 2014.
  • Of the state's remaining uninsured, 1 in 4 was between the age of 25 and 34, and more than half (57%) were Latino.
  • Within the employed population, more than 2 million workers, about 1 in 8, were uninsured.

This report is part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's health care marketplace. Find all Almanac reports at


Special Report: Strengthening Supports for Low-Income Older Adults and Caregivers

FEB 8, 2016 | Justice in Aging
Advocacy Starts at Home: Strengthening Supports for Low-Income Older Adults and Caregivers | Video
(View the video, read the blog post, and access other materials on family caregivers here.)

Margaret is a mom with two teenagers at home, a husband, and a full time job. Her mother Sadie lives alone on a limited income in an adjacent town. Margaret checks in on her every day, and is always on call for transportation to doctor’s appointments, help with bills, and groceries. Margaret is a family caregiver, one of nearly 35 million Americans providing unpaid care to an older adult.

A new paper by Justice in Aging, Advocacy Starts at Home: Strengthening Supports for Low-Income Older Adults and Caregivers, and accompanying video outline the challenges Margaret faces in helping her mother age safely at home in dignity.

As the population ages and the prevalence of cognitive disorders among older adults increases, policymakers and the media are paying more attention to the challenges of caregiving. These challenges are even more acute for low-income older adults and their families.

That’s why we’ve released this paper now, with the support of the Albert and Elaine Borchard Center on Law and Aging, to make recommendations for policy changes and expanded programs to better serve everyone, but especially low-income older adults and their caregivers.


Report Addresses California’s Shortage of Primary-Care Physicians

FEB 8, 2016 | Physicians News Network
CPCA Report: HORIZON 2030: Meeting California’s Primary Care Workforce Needs

The California Primary Care Association (CPCA), which represents community health centers that provide care to one in seven Californians, released a report that provides a sobering analysis of California’s healthcare workforce today while detailing key opportunities to meet the workforce needs of tomorrow.

The CPCA reports: “At current utilization, California will need an estimated 8,243 additional primary-care physicians by 2030, or 32% of its current workforce” (Pettersone, Cai, Moore, & Bazemonre, 2013). The report also notes that California’s ratio of primary-care physicians participating in Medi-Cal is approximately half of the federal recommendation.

One-third of Californians, or 12.7 million, are now covered by Medi-Cal (Karlamangla, 2015). California’s ratio of primary-care physician full-time equivalents (FTEs) participating in Medi-Cal was estimated at 35 to 49 per 100,000 Medi-Cal enrollees, well short of the 60 to 80 that the federal government estimated are needed (Coffman, Hulett, Fix, & Bindman, 2014).

According to the California Academy of Family Physicians, well-qualified new physicians who would like to train in the state instead must leave California due to limited residency opportunities, often not returning to practice in California (CAFP, 2015).

In 2014, for example, the White Memorial Family Medicine Residency Program in Los Angeles received 600 applications for seven slots; Family Health Centers of the San Diego Family Medicine Residency Program received 744 applications for six slots; and the UCSF Fresno Family Medicine Residency Program received 762 applications for 12 slots.

Combined California residency programs train approximately 140 family medicine residents per year. This is an insufficient amount to produce the number of primary-care physicians needed (CAFP, 2015).

According to the CAFP, California’s long-term workforce would grow significantly, as the vast majority of physicians who train in a region stay there to practice. Nearly 70% of medical residents who train in California practice here after graduation.

As reported on ABC 10, California’s population growth, coupled with an increase in insured Californians under the Affordable Care Act, means that the state’s primary-care doctors are in higher demand than ever. The implications are that people could have longer wait times to get into the doctor as well as fewer doctors to coordinate their care.

At a national level, The Robert Graham Center suggests education reform that includes medical-school debt relief, increased primary-care training, and reimbursement reform to attract more physicians to the primary-care field.


CMS Releases Guide to Reduce Health Disparities in Hospital Readmissions

FEB 5, 2016 | Justice in Aging

Reducing health disparities for racial and ethnically diverse Medicare beneficiaries is a key part of the Center for Medicare and Medicaid Services (CMS) health equity plan. Medicare hospital readmissions have implications for quality improvement, cost savings, and health equity. Unplanned readmissions cost Medicare $17.4 billion in 2004, and 20 percent of Medicare fee-for-service beneficiaries were readmitted within 30 days of discharge. Research has revealed that minority and other vulnerable populations are more likely to be readmitted within 30 days of discharge for certain chronic conditions, compared to white beneficiaries.

Last week, the Center for Medicare & Medicaid Services (CMS) Office of Minority Health released a guide to preventing readmissions among racially and ethnically diverse Medicare beneficiaries. This guide outlines key issues and offers strategies to prevent readmissions for racially and ethnically diverse patients, high level recommendations for moving the needle on readmissions for diverse populations, and case studies demonstrating how these recommendations work in practice. The guide also contains useful data for advocates that detail health disparities in the top conditions in the CMS hospital readmissions reduction program and health disparities in top chronic conditions.

While the guide focuses on hospital readmissions, the ideas to improve communications and continuity of care for racially and ethnically diverse Medicare beneficiaries can be applied in many settings. For example, the guide highlights the importance of language access – during the hospital stay, at discharge, and when accessing post-hospital care. Advocates can work with providers in their communities to promote these practices to combat health disparities among racial minorities and individuals with limited English proficiency.

At Justice in Aging we work to ensure that low-income seniors have access to the health care they need and that the programs and services they are entitled to by law are delivered without discrimination.


California's Health Care Safety Net: A Sector in Transition

JAN 14, 2016 | California HealthCare Foundation (CHCF)

California's Health Care Safety Net: A Sector in Transition covers a period of significant change, with the 2014 implementation of the federal Patient Protection and Affordable Care Act (ACA), which expanded Medi-Cal eligibility to most adults with incomes up to 138% of the federal poverty level (FPL) and established state health care exchanges that enables individuals to purchase insurance, often with federal subsidies..


Governor’s Budget is a Start But Doesn't Go Far Enough for Poor Seniors

JAN 2016 | Justice in Aging
Governor's Budget is a Start But Doesn't Go Far Enough for Poor Seniors

Rates of senior poverty in California are high and rising, with more than one million seniors in one of country’s wealthiest states struggling to pay rent, buy food, and cover health care costs. California Governor Jerry Brown released a proposed budget for fiscal year 2016-2017 that provided some relief, but more action and bolder policies are needed.


New Fact Sheet: Medicare Part D – 2016 Transition Right

JAN 2016 | Justice in Aging
Fact Sheet

The Centers for Medicare and Medicaid Services (CMS) requires that sponsors of Medicare Part D prescription drug plans provide beneficiaries with access to transition supplies of needed medications to protect them from disruption and give adequate time to move over to a drug that is on a plan’s formulary, file a formulary exception request or, particularly for Low Income Subsidy (LIS) recipients, enroll in a different plan.

Transition rules apply to stand-alone Medicare Prescription Drug Plans (PDPs), Medicare Advantage Plans with Prescription Drug Coverage (MA-PDs), and Medicare-Medicaid Managed Care Plans participating in the Dual Eligible Financial Alignment Demonstrations. Transition rules are particularly important for low income beneficiaries who were automatically reassigned to new plans, which may or may not cover their medications. In addition, all plans change their formularies each year, so even people who remain in the same plan may find that their plan no longer covers their medications or has newly imposed utilization management requirements.

To assist advocates with transition issues, this fact sheet sets out the CMS minimum requirements for all plans. For further information, contact Georgia Burke,




New Brief on Integrated Care Models for Dually Eligible Beneficiaries

DEC 17, 2015 | The SCAN Foundation

A new brief from the Center for Health Care Strategies describes key features and considerations for various integrated care models that states use to serve Medicare-Medicaid enrollees.


The Promise of Coordinated Care

DEC 17, 2015 | The SCAN Foundation

Two new success stories from Collaborative Consulting on the value of coordinated care:


Wave 2 of Polling Results of California's Medicare-Medicaid Enrollees

DEC 17, 2015 | The SCAN Foundation

Field Research Corporation released its second wave of polling results surveying people enrolling in and opting out of Cal MediConnect (CMC). Findings show that CMC enrollees have continued satisfaction and confidence in their care.


Four New Reports Available from the 2014 National Study of Long Term Care Providers


The National Center for Health Statistics (NCHS) has four new reports available based on findings from the 2014 National Study of Long Term Care Providers:

  • Data Brief #224: “Variation in Operating Characteristics of Adult Day Services Centers, by Center Ownership: United States, 2014”
  • Data Brief #227: “Variation in Adult Day Services Center Participant Characteristics, by Center Ownership: United States, 2014”

All data briefs can be found at

All data briefs have supplementary state estimate tables which can be found at


The data briefs and state tables use survey data from NCHS’ 2014 NSLTCP. NSLTCP provides reliable, accurate, relevant, and timely statistical information to support and inform long-term care services policy, research, and practice. More information about NSLTCP is available at


Regulatory Review of Adult Day Services

NOV 20, 2015 | US Dept of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE)

The US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE) recently released a report on Adult Day Services. The Regulatory Review of Adult Day Services, 2014 Edition provides information about each state’s approach to regulating this key community service. Adult day services (ADS)--a non-residential service provided outside an individual’s home for less than a full day--provides direct care to older adults and younger adults with physical disabilities.

The report was authored by RTI International including Janet O'Keeffe, Christine O'Keeffe and Madhu Shresthra.


Health Care Costs 101: A Spending Plateau?

NOV 2015 | California HealthCare Foundation (CHF), California Health Care Almanac

In 2013, national health expenditures increased just 3.6%, the lowest growth rate in 50 years and a continuation of the slow growth trend that began in 2009. See the latest Almanac report and updated data visualization.


Locally Sourced: The Crucial Role of Counties in the Health of Californians

How California counties provide health services for most vulnerable residents

OCT 2015 | California Healthcare Foundation

California's 58 counties are core providers of health care services and public health programs. Counties are responsible for health services for low-income people without other coverage, oversee local mental health and substance use disorder programs, operate laboratories, and manage disease prevention and health promotion programs.

To administer this array of health services, counties navigate a complex set of federal, state, and local funding streams and requirements. Over the years, responsibility for program administration, funding, and decisionmaking has been complicated by back-and-forth shifts between the state and counties.

With the unprecedented changes in health care delivery under the Affordable Care Act (ACA), county health programs are in a period of flux as new state and federal policies are implemented, revised, and reframed. The role of counties will continue to evolve as public and private health care markets mature under the ACA's framework of expanded health coverage and delivery system reform.

The latest edition of this report describes:

  • County health services and programs for medical care, behavioral health, and public health as of July 2015
  • Counties' core health responsibilities and the arrangements they use to meet them
  • State and federal policies affecting county programs (including some that are pending)


Directory Assistance: Maintaining Reliable Provider Directories for Health Plan Shoppers

SEPT 2015 | California Healthcare Foundation

With implementation of the Affordable Care Act (ACA), many consumers are making health coverage decisions for the first time. Many turn to provider directories — electronic or printed lists of physicians, hospitals, and other health care providers participating in each health plan. However maintaining accurate and up-to-date directories of participating providers has proved to be challenging.

A new report examines policy, operational, business, and technical obstacles to well-functioning, integrated provider directories and how they have been overcome in four states: Colorado, Maryland, New York, and Washington. It details the perspectives and experiences of consumer advocates, carriers, providers, state-based marketplaces, and state Medicaid agencies in those states. The report examines solutions with the goal of informing California policymakers and stakeholders as they seek to improve consumer access to accurate provider network information.

Key findings include:

  • An environment for shared accountability can be fostered through incentives, policy alignment, and enforcement of regulatory and contractual requirements.
  • Creation of uniform data standards and accompanying guidance ensures that data are usable, especially when they come from disparate sources.
  • Provider directories should engage and inform consumers with diverse language needs and educational levels as they enroll in coverage and seek care.


The CMS Equity Plan for Improving Quality in Medicare

SEPT 14, 2015 | Centers for Medicare & Medicaid Services Office of Minority Health
Full Plan

The Centers for Medicare & Medicaid Services (CMS) Equity Plan for Improving Quality in Medicare (CMS Equipty Plan for Medicare) provides an action-oriented, results-driven approach for advancing health equity by improving the quality of care provided to minority and other underserved Medicare beneficiaries. The plan aims to reduce health disparities in four years, and focuses on six priorities:

  • Priority 1: Expand the Collection, Reporting, and Analysis of Standardized Data
  • Priority 2: Evaluate Disparities Impacts and Integrate Equity Solutions Across CMS Programs
  • Priority 3: Develop and Disseminate Promising Approaches to Reduce Health Disparities
  • Priority 4: Increase the Ability of the Health Care Workforce to Meet the Needs of Vulnerable Populations
  • Priority 5: Improve Communication and Language Access for Individuals with Limited English Proficiency and Persons with Disabilities
  • Priority 6: Increase Physical Accessibility of Health Care Facilities


Initial Data from 2014 National Study of Long Term Care Providers

SEPT 11, 2015 | National Adult Day Services Association (NADSA)

In support of National Adult Day Services Week, the National Center for Health Statistics has released its first data from the 2014 National Study of Long Term Care Providers.

In 2014, cardiovascular disease (44%) was the most common diagnosis among adult day services center participants, while severe mental illness (10%) was the least common diagnosis. About 30% of adult day services center participants had a diagnosis of Alzheimer's disease or other dementias; 30% had diabetes; about 25% had intellectual or developmental disability; and 25% had depression. It is estimated that 282,200 participants were enrolled in adult day services in the United States on any given day in 2014.

View QuickStats: Percentage of Adult Day Services Center Participants,* by Selected Diagnoses† — National Study of Long-Term Care Providers, United States, 2014 in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention.


Los Angeles Healthy Aging Report 2015

SEPT 2015 | USC Edward R. Roybal Institute on Aging

Health is the most important determinant of successful living at any age. However, not everyone has the same opportunities for a long life free from major afflictions. There are significant differences in the health status of the many communities in Los Angeles. These differences are reflected in higher rates of premature dealth and shorter lifespans for people of certain racial and ethnic bakgrounds who live in certain neighborhoods. The challenge of our time is to implement successful changes in the way we live so that all of us can benefit from longer, more productive, and healthier lives.


Initial Data from 2014 National Study of Long Term Care Providers

SEPT 11, 2015 | National Adult Day Services Association (NADSA)

In support of National Adult Day Services Week, the National Center for Health Statistics has released its first data from the 2014 National Study of Long Term Care Providers.

In 2014, cardiovascular disease (44%) was the most common diagnosis among adult day services center participants, while severe mental illness (10%) was the least common diagnosis. About 30% of adult day services center participants had a diagnosis of Alzheimer's disease or other dementias; 30% had diabetes; about 25% had intellectual or developmental disability; and 25% had depression. It is estimated that 282,200 participants were enrolled in adult day services in the United States on any given day in 2014.

View QuickStats: Percentage of Adult Day Services Center Participants,* by Selected Diagnoses† — National Study of Long-Term Care Providers, United States, 2014 in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention.


New Report -- Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity

AUG 28, 2015 | California Department of Public Health Office of Health Equity

In this this document, the California Statewide Plan to Promote Health and Mental Health Equity (“Plan”), we present background and evidence on the root causes and consequences of health inequities in California. We explore and illustrate how a broad range of socioeconomic forces, including income security, education and child development, housing, transportation, health care access, environmental quality, and other factors, shape the health of entire communities — especially vulnerable and underserved communities — resulting in preventable health inequities for specific populations. With a better, data-based understanding of the causes and consequences of health inequities, Californians will be better prepared to take the steps necessary for promoting health across California’s diverse communities and building on the great strengths that our diverse population brings.

The Plan is intended to illuminate the scope of the health equity challenge with compelling data and narrative. It makes the case that health is a basic human right, that health inequity is a moral and financial issue, and that health equity is in everyone’s best interest. It also provides a brief summary of the most pervasive social determinants of health, and it offers examples of programs, policies, and practices that have begun to make a difference in the state’s most vulnerable communities.


New 50 State Survey of Dementia Training Requirements

AUG 24, 2015 | Justice in Aging
Survey Findings | Video Summary

With more than 5 million people living with Alzheimer’s and other dementias, there’s a growing need for robust training standards for health care professionals in the special needs of people with cognitive impairment. For example, though 64% of nursing home residents have dementia, only 23 states have laws prescribing training requirements for direct care staff in nursing homes and, of those, only one state requires staff to pass competency examinations. Only ten states require dementia training for law enforcement.

These are among the findings of an in-depth 50-state survey of statutes and regulations that Justice in Aging conducted with the support of the Alzheimer’s Association. We looked at dementia training requirements for professionals in a variety of health care and community settings and found wide variation among states in both the amount and the content of required training. We compiled our findings in a five-paper series, Training to Serve People with Dementia: Is our Health Care System Ready?

So advocates can easily find whether their state has standards in each area, Papers 2 through 4 include detailed tables of state laws and regulations in each category, complete with full citations.

We also presented a webinar outlining the major findings of the study and offering an initial roadmap for advocates working to address training gaps. You can view it on our Vimeo channel.


How Consumers Find Information About Prescription Coverage

AUG 19, 2015 | California Healthcare Foundation

When shopping for health plans, consumers face many challenges in finding information on prescription drug benefits. Publicly posted formularies are often difficult to navigate due to lack of standardization, may be presented in arcane terminology, provide incomplete and inaccurate information, and frequently are not available in languages other than English.

Hidden From View: How Consumers Find Information About Prescription Coverage provides insight into the consumer experience of accessing prescription drug coverage information, pinpoints consumer priorities and preferences for display of relevant benefit information, and identifies opportunities for making benefit information more accessible and easy to comprehend. Consumer input yielded many recommendations for making prescription drug benefit information easier to find and use.

The key findings and recommendations are:

  • The affordability of monthly premiums and other out-of-pocket costs, along with physician selection, trumped questions about drug cost and coverage, even for consumers with significant prescription drug requirements.
  • In general, respondents were not familiar with many of the terms used routinely in prescription benefit information, such as "formulary," "tier," "co-insurance," and "preferred." Consumers want materials written in more common, accessible language.
  • There was little awareness of the exceptions or appeals process for obtaining needed medications not listed on a plan's formulary. Those seeking this information had difficulty finding it.
  • Respondents, including Spanish-speakers who reported being comfortable reading English, said drug information, such as formularies, should be available in Spanish and other languages.
  • All consumers, counselors, and agents reported that an interactive, online tool that provides drug cost and coverage information by plan would improve consumer decisionmaking.

Information from ACA 411 can be readily exported and shared, and CHCF will add new data as they are available to track how health reform is changing health care for Californians. ACA 411 is designed to help policymakers and stakeholders understand the ACA's impact in California, identify areas for further investigation, and inform policy choices.


RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care

AUG 11, 2015 | California HealthCare Foundation

Facing a shortage of primary care physicians and a large increase in patients needing care, safety-net clinics are realizing the full potential of using the nursing workforce to better deliver care.


In or Out: An Examination of Medicaid's Coverage Determination Policies

AUG 2015 | California Healthcare Foundation

How do state Medicaid agencies decide what to cover?

Medicaid, the largest US purchaser of health services, plays a big role in whether millions of Americans can get new health care interventions. A new CHCF report reviews how Medicaid and other large public health insurance programs in the US and abroad determine coverage for specific treatments (e.g., procedures, therapies, technologies, and devices), including behavior change interventions and emerging technologies.

The report highlights themes from research and interviews with select state Medicaid agencies and discusses policies and procedures for achieving greater rigor and transparency in this decisionmaking process.

The authors conclude that state Medicaid programs, including California's Medi-Cal, should consider the following core features for their coverage determination policies:

  • A defined process by which third parties may initiate a coverage review
  • A systematic approach to securing and evaluating evidence of the effectiveness and value of a new intervention
  • A systematic evaluation of high-cost, high-utilization services
  • A defined standard by which the state will determine whether to cover the intervention


Planning for California's Growing Senior Population

AUG 2015 | Public Policy Institute of California (PPIC)

California’s senior population is entering a period of rapid growth. By 2030, as the Baby Boom generation reaches retirement age, the over-65 population will grow by four million people. It will also become much more racially and ethnically diverse, with the fastest growth among Latinos and Asians. Many more seniors are likely to be single and/or childless -- suggesting an increased number of people living alone. All of these changes will have a significant impact on senior support services.


As California Ages, Will There Be Enough Beds and Services?

New Reports Explore Health Service Capacity
AUG 2015 | California Health Care Almanac from the California Healthcare Foundation (CHCF)
Reports: Beds for Boomers | California Hospitals: An Evolving Environment

With the aging of the baby boomer generation and gains in life expectancy, California's senior population is projected to more than double by 2040. Because seniors use more health care services than other age groups, there are concerns about the capacity of the health care system to accommodate their needs. Two new publications from CHCF's California Health Care Almanac examine supply and demand from different perspectives. Below are highlights from each report.

Beds for Boomers: Will California's Supply of Services Meet Senior Demand? focuses on the projected need for services.

  • Nearly two-thirds of California seniors had two or more chronic conditions in 2012.

  • Californians over age 65 use acute care hospital days at rates up to four times more than younger people. However, since 2008, acute care days used by seniors have declined despite growth in this population.

  • Acute care days are projected to increase by nearly 50% by 2040 if current usage remains steady. Overall, California's 2013 supply of licensed acute care beds is sufficient to meet this projected demand.

California Hospitals: An Evolving Environment focuses on the existing supply of various types of beds in general acute care hospitals.

  • Skilled nursing and acute psychiatric beds declined significantly from 2004 to 2013, while both adult and newborn intensive care beds increased. During that decade, the number of general acute care hospitals fell by 4% while the number of beds remained largely unchanged.

  • The eight largest hospital systems accounted for 40% of hospitals and beds in California.

  • California hospitals performed slightly below the US average on eight patient satisfaction measures.

Note that the statistics between the two reports may differ due to the sets of hospitals covered. These reports are published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's health care marketplace. Find all Almanac reports at


The Dual Eligible Demonstrations at Five: Justice in Aging Toolkit on Design and Implementation

JUL 28, 2015 | Justice in Aging
Outreach and Enrollment Materials in States Implementing a Demonstration

On Thursday, we’ll celebrate the 50th anniversary of the day that two of the most successful anti-poverty programs became law: Medicare and Medicaid. Today, over 10 million low-income individuals, known as dual eligibles, receive care and services under both programs. In 2010, under a provision of The Affordable Care Act (Pub. Law 111-148, Section 2602), the Centers for Medicare and Medicaid Services (CMS) created a new office to focus exclusively coordinating the two programs. The new entity, the Medicare-Medicaid Coordination Office, began working with states across the country to better align Medicare and Medicaid benefits through state-run dual eligible demonstrations.

Five years later, states and CMS are in the early stages of evaluating the demonstrations and also looking at mid-course corrections and improvements based on experiences to-date. At the same time, advocates and policymakers are contemplating future health care delivery system reforms, as part of a broader reform effort to pay for value and outcomes, instead of volume.

To contribute to these efforts, Justice in Aging has created a toolkit of design and implementation resources. The toolkit consists of:

  • A new tool for advocates comparing different state outreach and enrollment materials to highlight effective models to use when reaching vulnerable populations. The new tool includes two appendices: Appendix 1, a working chart with links to outreach materials in different states. Appendix 2, accessible from the Outreach and Notices tab on this page, includes examples of notices currently in use in states, and our comments on strengths and areas of improvement.
  • Resources on appeals procedures, designing enrollment notices, care continuity, and ensuring consumer protections in integrated models. These resources were developed earlier by Justice in Aging to influence the demonstration’s design to ensure consumer protections were a focus of new managed care delivery systems. They are assembled together for the toolkit and linked from this page.


20 Common Nursing Home Problems and How to Resolve Them

JUL 2015 | Justice in Aging
Request Report (Free)

Can a nursing home deny needed therapy services? Evict a resident for being “difficult”? Limit family members and friends to specified “visiting hours”?

Many common nursing home practices are, in fact, illegal. In order to receive the best possible quality of care, a resident or resident’s family member should be familiar with the protections of the federal Nursing Home Reform Law, and understand how to use the law effectively.

That’s why Justice in Aging wrote a practical and widely-used consumer guide, 20 Common Nursing Home Problems and How to Resolve Them. The new version is completely updated and boasts a reader-friendly new design.


Valuing the Invaluable: 2015 Update
Undeniable Progress, but Big Gaps Remain

JUL 2015 | AARP Public Policy Institute

This report highlights the growing importance of family caregiving on the public policy agenda. It lists key policy developments for family caregivers since the last Valuing the Invaluable report was released in 2011. Finally, the report recommends ways to better recognize and explicitly support caregiving families through public policies, private sector initiatives, and research.


Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care

JUL 2015 | The California HealthCare Foundation (CHCF)

This report takes a close look at access to care under Medi-Cal for nonelderly adults and children on the eve of ACA implementation. Using data from 2012 and 2013 California Health Interview Surveys (CHIS), the research examines a total of 45 measures (41 on realized and potential access and 4 on health status and health behaviors) for nonelderly adults and 31 measures (28 on realized and potential access and 3 on health status and behaviors) for children.


Report: Stories from LGBT Older Adults in Long-Term Care Facilities

JUN 29, 2015 | Justice in Aging / LGBT Senior Long Term Care Bill of Rights / San Francisco Board of Supervisors
Report | Accompanying Video

Imagine being out and proud all of your adult life and then moving into a long-term care facility and having to go back into the closet because you don’t feel safe coming out to staff and other residents. Imagine being dismissed and disrespected when you advocate strongly for the rights of your same-sex companion while she’s being cared for in a nursing home. Imagine feeling like you have to endure homophobic comments from a personal care worker assigned to you because you’re afraid of how he’ll treat you if you speak up.

These anecdotes are not only true; they’re common experiences for LGBT older adults. And they’re all in our ground-breaking report, LGBT Older Adults in Long-Term Care Facilities: Stories from the Field. Published in 2010, the report is still making waves in policy circles. In honor of Pride 2015, we’re re-releasing a fresh version of the report for those who may have missed it, along with its accompanying video.

We’re proud that our report was the impetus for the San Francisco Board of Supervisors recent unanimous approval of an LGBT Senior Long Term Care Bill of Rights – the very first of its kind in the nation. We hope that other cities use San Francisco’s ordinance as a model to ensure LGBT seniors have the right to be safe and treated with dignity in every long-term care facility. That’s why we’re re-releasing the report now.

As we celebrate the Supreme Court ruling on June 26 for marriage equality for same-sex couples across the nation, we recognize what a huge step this is for LGBT older adults. At the same time, we know that we must remain committed to fighting the discriminatory practices that linger in the system.


Understanding Medi-Cal High-Cost Populations

JUN 9, 2015 | California Healthcare Foundation (CHCF)
Documents/Recording High Utilizers of Medi-Cal Services | Infographic Medi-Cal by the Numbers High-Use High Cost

California's government collects vast amounts of clinical and cost data about the care it provides to the 12 million people enrolled in Medi-Cal, the nation's largest Medicaid program.

Aggregating and analyzing this data, which is spread across multiple departments, is a key to understanding the Medi-Cal population, identifying opportunities to improve health care and outcomes, and managing public spending. Document downloads include:

  • Slides – Understanding Medi-Cal High Utilizers (Kizer and Watkins)
  • Slides – Understanding Medi-Cal High-Cost Populations (Watkins)
  • Slides – Improving Service Delivery for High Need Medicaid Clients in Washington State (Mancuso)
  • Slides – Integrated Care Models and Outcomes for Clients with Co-Morbid Conditions (Innes-Gomberg)
  • Slides – Long-Term Services and Supports: Shaping the Delivery System (Schupp)
  • Slides – Using Data to Improve Care: Perspectives on Long-Term Services and Supports (Steenhausen)
  • Slides – Keynote and Demonstration of Washington State’s Predictive Risk Intelligence System (PRISM) (Mancuso)


ADA at 25: Aging Advocates Celebrate Partnership And Progress

JUN 2015 | Justice in Aging
Issue Brief

This paper will provide aging advocates with some background on the ADA and outline four key areas where the ADA continues to shape the environment, care, and services for older adults. As aging and disability advocates continue to partner to advance policy, it’s important to remember how much the ADA accomplished in just twenty-five years.


Advocates Guide to California's Coordinated Care Initiative Version 4

JUN 2015 | Justice in Aging
Advocate's Guide, Version 4

Justice in Aging created an Advocates Guide to California's Coordinated Care Initiative to help advocates understand the extensive changes occurring under the CCI. Today, Justice in Aging released Version Four of the Guide, which:

  • Describes the CCI, including populations affected, changes beneficiaries can expect, and where and when the CCI is being implemented
  • Summarizes CCI policies
  • Provides advocacy tips and additional resources


Just Like Home: The Impact of the Federal HCBS Regulations on Older Adults

JUN 2015 | Justice in Aging
Issue Brief

New federal regulations have established first-time standards for when settings qualify as “community-based” for the purposes of Medicaid-funded Home and Community-Based Services (HCBS). Each state is charged with developing a transition plan to meet these standards. These plans will have a huge impact on older adults receiving Medicaid-funded HCBS in assisted living, adult day services, and other settings.

The transition plans must confront and answer many important questions.

  • What service models are eligible for payment?
  • Should services in assisted living facilities be covered?
  • What about adult day care programs?
  • Does the size of these programs matter?
  • And should programs be allowed to be “secure”, i.e., locked, if they care for persons with dementia?

Consumers and their advocates must be heard in the states’ transition planning processes. Justice in Aging’s new issue brief provides policy recommendations for consideration by states and stakeholders. The recommendations address (among other things) how to assess settings for compliance, judging whether a setting is integrated with the community, protecting consumers from eviction, and applying the regulations when consumers have dementia.


Regulatory Review of Adult Day Services: Final Report, 2014 Edition

JUN 2015 (Released) | U.S. Department of Health and Human Services, Assistance Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy
DEC 2014 Report / PDF version

The 2014 Regulatory Review of Adult Day Services by state has been released by the Assistant Secretary for Planning and Evaluation. This report updates their previous report published in 2005, and is organized into two sections:

  • Section 1 provides a brief overview of states’ approaches to regulating ADS in selected areas -- the state’s general approach to regulation, inspection and monitoring; parameters for who can be served; required and optional services; provisions regarding medication; and staffing and training requirements.
  • Section 2 provides a profile for each state that describes its overall approach to regulating ADS providers, selected regulatory provisions, and Medicaid and other public funder requirements (if any).


Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs

APR 2015 | Centers for Disease Control and Prevention (CDC)

This “how-to” guide is designed for community-based organizations who are interested in implementing their own evidence-based fall prevention programs. This guide is designed to be a practical and useful tool, and it provides guidelines on program planning, development, implementation, and evaluation.

In this document, CDC provides organizations with the building blocks of effective fall prevention programs by providing examples, resources, and tips. It also describes the resources needed to implement and sustain fall prevention programs, and addresses questions that are important when implementing fall prevention programs such as:

  • How do we find a fall prevention program that best meets the needs of our clients?
  • How can we know that this program works and will achieve the desired results?
  • What resources will be needed to support it?
  • What partners should we consider to help us offer the program?
  • How can we support and sustain the program into the future?

This revision of the 2008 publication, Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults, will improve your organization’s ability to reach out to the older members of your community as well as enhance your capacity to implement and maintain effective fall prevention programs.


Californians with the Top Chronic Conditions: 11 Million and Counting

APR 2015 | California Healthcare Foundation (CHCF) / UCLA Center for Health Policy Research
Report | Charts

Chronic conditions are the leading cause of death and disability in the US, and the biggest contributor to health care costs. But there is wide variation in their incidence, with major differences depending on age, income, race and ethnicity, and insurance status. In addition, many Californians with chronic conditions are delaying needed care because of cost.

Californians with the Top Chronic Conditions: 11 Million and Counting looks at five major chronic conditions — asthma, diabetes, heart disease, high blood pressure, and serious psychological distress — and how each of these affects Californians.


A Right to Person-Centered Care Planning

APR 2015 | Justice in Aging
Report | Accompanying Webinar

When people are given the opportunity to choose where, how, and by whom they receive their care; and make their own decisions about their activities of daily living, and generally direct their own lives to the greatest extent possible, they have better health outcomes, more independence, and lead more fulfilling lives. This is at the heart of a concept known as person-centered care planning. With the support of the John A. Hartford Foundation, Justice in Aging released a report on the new Person-Centered Planning rules for Medicaid Recipients in Long Term Care from Centers for Medicare and Medicaid Services (CMS).

The report, A Right to Person-Centered Care Planning, and an accompanying webinar, summarize the rights the new rule gives to beneficiaries as well as identifying for advocates where there are gaps in the rule and where more guidance is needed. Best practices in the states are also included to serve as models for advocates working to ensure true person-centered care planning is a reality for all.


Medicaid HCBS Settings Regulations and Adult Services

APR 2015 | National Association of State United for Aging and Disabilities (NASUAD)

Concerned that the CMS definition for HCBS Settings places restrictive requirements on Adult Day Services settings and may reduce the number of available providers in the Medicaid program nationwide, the National Association of States United for Aging and Disabilities (NASUAD) conducted a survey. Key findings indicate the HCBS regulations may have the unintended consequence of limiting the availability of important health and social services, with the unintended consequence of individuals entering institutional settings.


Issues from the State: Advocating for Improved Consumer Protections in Managed Long-Term Services and Supports

APR 24, 2015 | Justice in Aging, with thanks to The Retirement Research Foundation and The Atlantic Philanthropies for their support in producing this paper
Issue Brief

State Medicaid programs increasingly are moving their long-term services and supports programs to managed care. But the transition is not without its potential pitfalls for Medicaid beneficiaries and their advocates. A new issue brief spotlights the managed LTSS programs from Florida, Kansas, and New Jersey, and discusses how particular program policies may influence availability of services and the ability of consumers to access those services. The information presented will be of use to advocates from any state with a Medicaid managed care program, and will address both individual and systemic advocacy strategies.


Survey Says: Californians' Perspectives on Health Care

APR 14, 2015 | California Healthcare Foundation (CHCF)
Survey Findings | California Health Care Almanac

Are Californians getting the care they need? This survey shows that some groups are having a more difficult time accessing care than others.

While there is recent good news in terms of expanding health coverage, too many Californians struggle to get access to health care. This is particularly true of those with the greatest need: One in two adults who report they are in fair or poor health have delayed care in the past 12 months due to cost.


Genworth 2015 Annual Cost of Care Study

APR 9, 2015 | Genworth News Release
Cost of Care website

At Home Care Costs Increase in California

The results of Genworth's 12th annual Cost of Care Study shows that in California, the cost to receive long term care services at home with a home health aide has increased over the past five years. On a national level, the survey shows a dramatic increase in facility based care, including assisted living and nursing home facilities, while the cost to receive care at home through a home health aide is rising at a more moderate growth rate.


Thinking Outside the Box: Creative and Culturally Competent Outreach Strategies in Health Care Transitions

MAR 2015 | Justice in Aging & co-authored by Advocates for African American Elders (AAAE)
Issue Brief

Changes to health care coverage are happening rapidly and can be confusing for advocates to understand and explain to beneficiaries.

This issue brief discusses, in general, the importance of effective outreach and education during any complex health care transition. As a real world example, it focuses on how AAAE’s culturally competent outreach model communicates changes under California’s Coordinated Care Initiative to dual eligible beneficiaries, who are being moved into managed care plans.

The brief offers insight into and instruction on how to communicate changes in a person-centered and engaging manner. It concludes with practical tips for advocates and stakeholders and should be of use to those who are preparing their own communities for complex health care transitions.


New Reports Shine Light on Long-Term Care Problems

FEB 23, 2015 | California Healthline Article


California Health Insurers: Brink of Change -- A snapshot in time just ahead of ACA implementation

FEB 2015 | California HealthCare Foundation (CHCF)
Report | Infographic

This report provides a snapshot of the insurance market in California at the end of 2013, just before the major provisions of the Affordable Care Act (ACA) took effect. It also includes some initial figures from 2014 that point to large shifts in both Medi-Cal and individual coverage levels.


The Universal Assessment Tool: Improving Care for Recipients of Home- and Community-Based Services

JAN 22, 2015 | Legislative Analyst's Office (LAO)


A Shattered System: Reforming Long-Term Care in California -- Envisioning and Implementing an IDEAL Long-Term Care System in California

JAN 5, 2015 | California State Senate Select Committee on Aging and Long Term Care




Regulatory Review of Adult Day Services: Final Report, 2014 Edition

DEC 2014 | Office of The Assistant Secretary for Planning and Evaluation (ASPE)
Full Report | California

Adult day services (ADS)--a non-residential service provided outside an individual's home for less than a full day--provides direct care to older adults and younger adults with physical disabilities. These services also meet caregivers' need for respite in order to work, fulfill other obligations, and recover from the demands of continuous caregiving.

Many caregivers who use ADS are providing care to family members with dementia who need constant supervision to ensure their safety. By providing respite to unpaid caregivers, ADS can potentially delay or prevent nursing home placement.

This report provides information about each state's approach to regulating this key community service.


Unfinished Business: Designing Appeals Procedures in the Dual-Eligible Demonstrations

DEC 2014 | Justice in Aging
Issue Brief

Under the Affordable Care Act, a number of states are participating in financial alignment demonstrations that combine the delivery of Medicare and Medicaid services for dual eligible beneficiaries. Even though financial alignment demonstrations are already “live” in five states with tens of thousands receiving services through demonstration plans, the appeal systems for the demonstrations in all participating states are still a work in progress, making it difficult for beneficiaries to navigate.

This tool, Unfinished Business, is an update on NSCLC’s September 2013 analysis of appeals processes in demonstrations in six states. Unfinished Business helps stakeholders focus their advocacy about appeals on areas where a consumer voice can have the most potential to affect programs, by highlighting the many areas where appeal rights and procedures have not yet been fully developed.

Ten states are participating (CA, IL, MA, MI, NY, OH, SC, TX, VA and WA), with one more, Minnesota, pursuing a similar but alternate model.


Working in Concert: A How-To Guide to Reducing Unwarranted Variations in Care

NOV 25, 2014 | California Improvement Network / California HealthCare Foundation (CHCF)

Patients should receive the appropriate level of care — no more and no less. But how is that sweet spot determined? This How-To Guide to Reducing Unwarranted Variations in Care, the result of the CIN's first action group, helps organizations get started.


Quality of Care: Signals of Change

NOV 6, 2014 | California HealthCare Foundation (CHCF)

From birth to death, the quality of health care being delivered in California has improved on several important measures in recent years. But significant racial and ethnic disparities persist, particularly for infant and maternal mortality.

Published as part of CHCF's California Health Care Almanac, this report looks at the quality of care in California on a variety of measures, including childbirth, children's health, and management of patients with common chronic conditions. It also provides data on mental health care, patient safety, nursing homes, home health, and end-of-life care.


What's In A Notice? How Notices Of Action Protect Consumers in Medicaid Managed Long-Term Services and Supports

NOV 2014 | Justice in Aging

As Managed Long Term Services and Supports (MLTSS) rolls out nationwide, advocates on the ground have seen due process violations in appeals and notices of action. In this tool for advocates and consumers, NSCLC focuses on notice and appeal rights in MLTSS. NSCLC provides background information on notices of action, including an explanation of what type of Managed Care Organization (MCO) behavior constitutes an action that could give rise to due process violations.

This tool also provides advocates with the specific information that must be included in each notice of action to meet due process requirements, and outlines how continuation of services and aid-paid-pending plays out in the managed LTSS context.


State Transition Plans for New Medicaid HCBS Regulations: Four Tips for Consumer Advocates

OCT 2014 | Justice in Aging and National Disability Rights Network
Four Tips for Consumer Advocates

States now are beginning to release their transition plans to bring their Medicaid HCBS systems into compliance with the new federal regulations on community-based settings. It is essential that consumers and their representatives be prepared to evaluate those plans and advocate for improvements.


Adult Day Services: A Model of Person- and Family-Centered Care

OCT 2, 2014 | AARP
BLOG by Lynn Friss Feinberg

A recent study found that more than a quarter million participants attend an estimated 4,800 community-based adult day service (ADS) centers in the U.S. Although most participants are older people, more than one-third of ADS participants are younger than 65. Nearly one in three ADS participants has Alzheimer’s disease or another form of dementia.


Shared Decisionmaking

OCT 2014 | California Improvement Network / California HealthCare Foundation (CHCF)

It is not always easy for providers and patients to make treatment decisions jointly. A new CIN partner report details effective strategies shared by the Gordon and Betty Moore Foundation, Humboldt-Del Norte IPA, and Sharp HealthCare.


Estate Recovery Under Medi-Cal

SEP 30, 2014 | California HealthCare Foundation (CHCF)
Issue Brief

California's Medi-Cal estate recovery program has received renewed attention from policymakers because of reports that some individuals newly eligible for Medi-Cal as expanded under the Affordable Care Act may not enroll for fear that their house and assets could later be seized. The purpose of this issue brief is to describe Medi-Cal estate recovery and to clarify who could be subject to it and under what circumstances.


Up Close: A Field Guide to Community-Based Palliative Care in California

SEPT 2014 | California HealthCare Foundation (CHCF)
Field Guide

Health systems across the US are recognizing the importance of palliative care — specialized, interdisciplinary care that attends to the physical, psychological, emotional, and spiritual needs of people with serious illnesses and their family members. While inpatient palliative care programs have proliferated, community-based programs — those that offer services at a clinic, in a patient's residence, or over the phone — are far less prevalent, and those that do exist have developed in relative isolation.

In 2013 the California HealthCare Foundation (CHCF) launched the Palliative Care Action Community to promote collaboration among organizations working to strengthen or expand their community-based palliative care (CBPC) services. Participating provider teams represented diverse types of organizations, provided services in a variety of settings, and came with varying levels of CBPC experience. Despite these differences, the teams shared common approaches and challenges in program planning, operations, and evaluation.


Data Briefs Released for 2012 National Study of Long Term Care Providers (NSLTCP)

SEPT 2014 | Centers for Disease Control and Prevention (CDC)
National Study of Long Term Care Providers (NSLTCP)

The Long-Term Care Statistics Branch released adult day services-specific state web tables, using data from the first wave of the National Study of Long-Term Care Providers (NSLTCP) conducted in 2012. NSLTCP is a new initiative by the National Center for Health Statistics (NCHS) to provide reliable, accurate, relevant and timely statistical information to support and inform long-term care services policy, research, and practice.

The main goals of NSLTCP are to: (1) estimate the supply and use of paid, regulated long-term care services providers; (2) estimate key policy-relevant characteristics and practices; (3) produce national and state-level estimates, where feasible; (4) compare estimates among sectors; and (5) monitor trends over time.


Can Reality Match Rhetoric? Person Centered Service Planning in Managed Long-Term Services and Supports

AUG 2014 | Justice in Aging
Policy Issues Brief

Person-centered planning is critical to the well-being of consumers of long-term services and supports. It works by identifying the strengths preferences, needs, and desired outcomes of the individual. In order for person-centeredness to be more than an empty slogan, it must be accompanied by substantive standards set forth in managed care organization (MCO) contract language. Some states have begun to include person-centered planning requirements in their contracts, but more work is needed before all states have a full framework.

This brief begins with a short description of service planning in the Medicaid managed care context. Next, it provides an analysis of what states are doing in their managed care contracts to ensure person-centered planning. Finally, the brief describes how the new federal home and community-based services (HCBS) rule will provide service planning protections for consumers that should be included in and built upon in MCO contracts.


Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions

AUG 19, 2014 | News Release from AARP and United Hospital Fund

The United Hospital Fund and AARP Public Policy Institute issued a report with compelling new evidence that family caregivers who provide complex chronic care to people who also have cognitive and behavioral health conditions face particularly demanding challenges, including high levels of self-reported depression. As a result, a majority of them (61 percent) reported feeling stress “sometimes to always,” between their caregiving responsibilities and trying to meet other work or family obligations.


Physician Participation in Medi-Cal: Ready for the Enrollment Boom?

AUG 5, 2014 | California HealthCare Foundation (CHCF)

By the end of 2015, the Affordable Care Act will add more than two million enrollees to Medi-Cal, the nation's largest state Medicaid program. This estimate has heightened concerns about whether there are enough doctors to care for them all. Californians are likely to have difficulty accessing health care through Medi-Cal unless the number of participating physicians grows or California finds other ways to deliver services. The percentage of physicians treating any Medi-Cal patients increased between 2011 and 2013 from 64% to 69%, according to a new report prepared by researchers at the University of California, San Francisco. Yet their findings suggest that Medi-Cal enrollees face significant challenges due to statewide variations in physician availability.


Here's Looking At You: How Personal Health Information is Being Tracked and Used

JUL 15, 2014 | California HealthCare Foundation (CHCF)
Report and InfoGraphic

Last month, in a US Supreme Court decision barring the warrantless searches of cellphones, Chief Justice John Roberts declared that a cellphone "contains the sum of an individual's private life" and can reveal more information than the search of an entire house.

Every day, in the course of using cell phones, credit cards, search engines, websites, and an array of medical devices, we leave behind digital footprints. These data flows, which often occur without our knowledge, have the potential to paint an individual health profile, as well as describe whole communities based on location, health conditions, or other factors.


Health Care Costs 101: Slow Growth Persists

JUL 8, 2014 | California HealthCare Foundation (CHCF)
Report | InfoGraphic | All Almanac Reports

Even with the slow growth in national health spending in recent years, the US continued to spend a greater percentage of its wealth on health care than any other industrialized nation, according to the latest edition of Health Care Costs 101. In 2012, the US spent an average of $8,915 per person on health care, reaching a total of $2.8 trillion. An interactive graphic shows the change in health care spending by payer from 1960 to 2012.


ACA 411: An Interactive Tool for Tracking Health Reform in California

JUN 17, 2014 | California HealthCare Foundation (CHCF)
ACA 411 Data Tool

The California HealthCare Foundation (CHCF) has created an interactive data tool to keep tabs on the trends that emerge as California continues to implement the Affordable Care Act (ACA) legislation. The tool tracks health care reform's effects in three areas: insurance coverage, access to health care services, and affordability.


2014 Scorecard: California's Long-Term Services and Supports for Older Adults, People with Disabilities, and Family Caregivers

JUN 17, 2014 | AARP and SCAN Foundation and The Commonwealth Fund
Scorecard | Policy Brief | California's Results

The 2nd State Scorecard on Long-Term Services and Supports shows California ranked 9th overall. While California ranks higher than most states, much work remains to be done to improve affordability, quality, and coordination of services within the state’s system of care to ensure that older adults and people with disabilities can access needed services to support independence and quality of life. The Scorecard is the first step in initiating a conversation about system performance, areas for opportunity, and the importance of continued system transformation in California.

Visitors to the Long-Term Services and Supports website can interact with the data by drilling into performance indicators for a single state, comparing data across states, or using a map to quickly compare overall state rankings.


2014 Alzheimer's Facts & Figures Report

MAR 19, 2014 | Alzheimer's Association
2014 Alzheimer’s Disease Facts and Figures

2014 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This information includes definitions of the various types of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality and morbidity, caregiving and use and costs of care and services. The Special Report discusses women and Alzheimer’s disease.


California and its Counties Under the ACA: A Leadership Framework

MAY 2014 | California HealthCare Foundation (CHCF)

As California moves to carry out the federal Affordable Care Act (ACA), it is implementing major health program, policy, and fiscal changes that will once again transform the state-county partnership. As a prelude to state monitoring and oversight of these sweeping changes, this issue brief offers policymakers and stakeholders:

  • A leadership framework to assess potential impacts of shifting responsibility for health programs and services between the state and local level.
  • Highlights of state policy and ACA implementation activities most likely to affect counties.
  • Application of the leadership framework to state and county roles in 2014.
  • Things to watch for in California counties as ACA implementation unfolds.


Long-Term Care in America: Expectations and Reality

MAY 19, 2014 | AP/NORC Center for Public Affairs Research

Findings from the 2nd long-term care poll by AP-NORC have been released. These polls are being conducted in order to produce new and actionable data about the aging population to inform the national dialogue surrounding long-term care issues.


Just Like Home: An Advocate's Guide to Consumer Rights in Medicaid HCBS

MAY 2014 | Source: Justice in Aging

New federal Medicaid rules, for the first time, set standards to ensure that Medicaid-funded home and community-based services (HCBS) are provided in settings that are non-institutional in nature. These standards, which took effect in March 2014, apply to residential settings, such as houses, apartments, and residential care facilities like assisted living facilities. The standards also apply to non-residential settings, such as adult day health care programs.


Monitoring Access: Measures to Ensure Medi-Cal Enrollees Get the Care They Need

MAY 2014 | California Healthcare Foundation (CHCF)

This report offers a framework and a targeted set of measures for monitoring access to ambulatory care for individuals enrolled in the Medi-Cal program. It is intended as an actionable starting point for elected leaders, state and federal program officials, and other stakeholders, to help them monitor changes in access to care over time, to identify disparities in access to care across subgroups or geographic regions, and to compare access between Medi-Cal enrollees and other insured populations in California and nationally.


In Transition: Seniors and Persons with Disabilities Reflect on Their Move to Medi-Cal Managed Care

APR 23, 2014 | California HealthCare Foundation (CHCF)

Researchers from the University of California, Berkeley, present findings from a survey of more than 1,500 SPD Medi-Cal enrollees who made the transition to Medi-Cal Managed Care. The report offers suggestions for improving transitions to managed care involving populations with complex needs, including those dually eligible for Medicare and Medicaid, and examples of actions taken by DHCS in response to the study's findings.


America's Long-Term Care Crisis: Challenges in Financing and Delivery

APR 2014 | Bipartisan Policy Center (BPC)

America's Long-Term Care Crisis: BPC Launches Initiative to Find a Politically and Fiscally Viable Path Forward to Improve the Financing and Delivery of Long-Term Care

This report sets the stage for BPC’s recommendations by identifying the major challenges and key questions in the financing and delivery of LTSS for both seniors and individuals under age 65.


Genworth 2014 Cost of Care Study

MAR 25, 2014 | Genworth
Executive Summary | Full Report

Over the past 11 years, Genworth has been able to recognize and identify trends across the long term care services landscape. The 2014 Genworth Cost of Care study looked at Homemaker Services, Home Health Aide Services, Adult Day Health Care (ADC), Assisted Living Facility (ALF) and Nursing Home Care.

Among the key findings for Adult Day Health Care (ADC): National Median Daily Rate: $65 | Increase Over 2013: 0% | Five Year Annual Growth: 3.4%*.

*Percentage increase represents the compound annual growth rate for surveys conducted from 2009 to 2014.


Daily Stressors and Adult Day Service Use by Family Caregivers: Effects on Depressive Symptoms, Positive Mood, and Dehydroepiandrosterone-Sulfate

FEB 3, 2014 | The American Journal of Geriatric Psychiatry
Abstract by Steven H. Zarit, PhD, et al

This study examines effects of daily use of adult day service (ADS) programs by caregivers of individuals with dementia (IWD) on a salivary biomarker of stress reactivity, dehydroepiandrosterone-sulfate (DHEA-S), and whether these effects on DHEA-S are associated with daily variability in positive mood and depressive symptoms.


Long-Term Care: What Are The Issues?

FEB 2014 | Robert Wood Johnson Foundation
Issue Brief

The demand for long-term care services will explode as the population ages and more people live longer with chronic conditions. Who will pay for these services and how will they be delivered?




California's Uninsured: By the Numbers

DEC 19, 2013 | California HealthCare Foundation (CHCF)

California's Uninsured: By the Numbers provides a look at California's uninsured population before full implementation of the ACA.


Monitoring Performance: A Dashboard of Medi-Cal Managed Care

DEC 18, 2013 | California HealthCare Foundation (CHCF)

This first public performance dashboard of Medi-Cal managed care shows areas of strength and opportunities for improvement.


Long-Term Care Services in the United States: 2013 Overview

DEC 12, 2013 | National Center for Health Statistics (NCHS)

The National Center for Health Statistics released a 93-page report based on findings from the National Study of Long-Term Care Providers (NSLTCP). The study considered long-term care services provided by adult day services centers, home health agencies, hospices, nursing homes, and assisted living and similar residential care communities. The key goals of the periodic study are to:

  • Estimate the supply of paid, regulated long-term care services providers
  • Estimate key policy-relevant characteristics of these providers
  • Estimate the number of long-term care services users
  • Estimate key policy-relevant characteristics of these users
  • Compare provider sectors
  • Produce national and state estimates, where feasible
  • Monitor trends over time


Medicaid Expansion in California: Opportunities and Challenges for Older Adults and People with Disabilities

NOV 2013 | Justice in Aging
Issue Brief

A new NSCLC issue brief provides an overview of new coverage options and how they impact low-income older adults and people with disabilities. The brief also explores how people receiving coverage under Medicaid expansion and exchanges will transition into Medicare coverage when they turn 65 or otherwise become eligible. While the issue brief focuses on how these issues play out in California, much of the information is relevant to advocates and policymakers in other states as well.


Health Information Technology in California: Milestones and Miles to Go

NOV 2013 | California HealthCare Foundation (CHCF)

This report shows interest continues to grow among Californians in using technology to support their health care needs, with 60% saying they would like online access to their health information. Similar percentages want the ability to schedule appointments online, receive appointment reminders, and email their medical professionals.


Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

SEPT 2013 | The Commonwealth Fund

Of all the challenges we face in health care, variation in system performance and disparities in health outcomes are among the most persistent and troubling. The Commonwealth Fund's new Scorecard on State Health System Performance for Low-Income Populations, 2013 sheds light on these problems and identifies opportunities for states to improve their health systems for economically disadvantaged populations.


New HIPAA Privacy Policies and Procedures Manual

Regulatory Alert | Order Form

On September 23, ALL Adult Day Health Care / CBAS facilities that are subject to the HIPAA privacy and security rules must come into compliance with the “HIPAA Omnibus Rule” which implements changes required by the HITECH Act of 2009. Any facility engaging in electronic transmission of protected health information is included. Failure to have internal guidelines in place that comply with the new Rule can lead to fines and other sanctions after September 23, 2013.

A fully updated Privacy Policies and Procedures Manual, designed to be easily customizable to your center, is available from CAADS. This manual replaces the previous CAADS HIPAA Policy and Procedures Manual in its entirety.


Long Term Care in California: Ready for Tomorrow's Seniors?

AUG 2013 | California HealthCare Foundation (CHCF)
Report | Long Term Care Facts and Figures (NOV 2009)

The leading edge of the baby-boom generation is beginning to flood California's long term care system. And the population of residents 65 and older is projected to triple by 2060. This report describes the state's supply and use of long term care services, including Medicare and Medicaid spending on services, and quality of care. The oversight and regulation of long term care services varies by provider, resulting in limited information — especially quality data — about assisted living facilities, personal care providers, and other home- and community-based services.

Also see:  Long Term Care in California: Ready for Tomorrow's Seniors?


Pathways to Progress in Planning for Long-Term Care

AUG 13, 2013 | AP/NORC Center for Public Affairs Research, with funding by The SCAN Foundation
Survey Results

Langer Research Associates launched an in-depth analysis of the April 2013 AP/NORC Center for Public Affairs Research poll. Findings show that people who know where to get information on long-term care are more apt to prepare for those needs.


State-by-State Profiles on Direct-Care Workforce

AUG 2013 | PHI Data Center
Web Tool | California's profile

This unique state-by-state web tool now includes standards for home health, personal care, and nursing aides. View California's profile of Workforce Size, Employment Projections, Wages, Health Coverage, Public Assistance, Training, Legislation/Regulation, Best Practices and Resources.


A State-by-State Snapshot of Poverty Among Seniors: Findings From Analysis of the Supplemental Poverty Measure

MAY 20, 2013 | Kaiser Family Foundation
Issue Brief

Key Findings:

  • The share of seniors living in poverty is higher in every state under the supplemental measure than under the official measure, and at least twice as high in 12 states, including California.
  • The share of seniors living in poverty under the supplemental measure is especially high in some areas. Based on the supplemental measure, about one in four seniors (26%) are living in poverty in DC and roughly one in five seniors are living in poverty in six states, including California (20%).
  • Nationally, nearly half of all seniors (48%) live with incomes below 200 percent of the poverty threshold under the supplemental measure, compared to 34 percent under the official measure.
  • At least half of seniors have incomes below 200 percent of poverty in 10 states and DC based on the supplemental measure, including California (56%).


The Effects of Adult Day Services on Family Caregivers' Daily Stress, Affect, and Health: Outcomes From the Daily Stress and Health (DaSH) Study

MAY 20, 2013 | The Gerontologist

In this study, we examine the effects of use of adult day service (ADS) by caregivers of individuals with dementia (IWD) on daily stressors, affect, and health symptoms. Participants were interviewed for 8 consecutive days. On some days, the IWD attended an ADS program and on the other days caregivers provide most or all of the care at home.


Long-Term Care: Perceptions, and Attitudes among Americans 40 or Older

APR 2013 | Associated Press-NORC Center for Public Affairs Research
Poll Findings

According to this new poll, Americans underestimate their chances of needing long-term care as they get older - and are taking few steps to get ready. Conducted by the Associated Press-NORC Center for Public Affairs Research, funded by The SCAN Foundation, the poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging.

Related article:
Americans Seriously Unprepared for Long-Term Care, Survey Finds (PBS NEWSHOUR, 4/24/2013)


Cal MediConnect Program

APR 2013 | The SCAN Foundation
Fact Sheet

Cal MediConnect: A Summary of the Memorandum of Understanding Between California and the Centers for Medicare and Medicaid Services is a 13 page fact sheet issued by the SCAN Foundation. The fact sheet provides background information and summarizes key points of the MOU that formalized a federal-state partnership to implement the Dual Eligibles Integration Demonstration known as "Cal MediConnect."


Long Term Services and Supports Program Compendium

APR 17, 2013 | The SCAN Foundation

The Long Term Services and Support Program Compendium, issued by The SCAN Foundation, is a compendium of federal and state agencies and departments supporting Long-Term Services and Supports Systems (LTSS).


LTC Commission Should Right Imbalance in How Medicaid Pays for LTSS

MAR 2013 | Justice in Aging

The HCBS Opportunity: Recommendations for the Commission on Long-Term Care

President Obama recently appointed the final members of the Commission on Long Term Care. Over the next six months the Commission must accomplish one objective: develop a plan for the establishment, implementation and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports (LTSS) for individuals who need LTSS.


Transitioning the SPD Population to Medi-Cal Managed Care: Examining the Experiences of Beneficiaries

MAR 28, 2013 | California HealthCare Foundation (CHCF)

The video and slides from the March 28, 2013 California HealthCare Foundation briefing, Transitioning the SPD Population to Medi-Cal Managed Care: Examining the Experiences of Beneficiaries, may be viewed on the CHCF website.


Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations

FEB 20, 2013 | UCLA Center for Health Policy Research
Health Policy Brief

The policy brief, Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations, reveals that HMO enrollees with limited English proficiency, and particularly those in fair to poor health, face communication barriers despite language assistance regulations. More than 1.3 million California HMO enrollees ages 18 to 64 do not speak English well enough to communicate with medical providers and may experience reduced access to high-quality health care if they do not receive appropriate language assistance services.


California’s Proposed 2013-14 Budget: Impact on California’s Seniors and People with Disabilities

JAN 2013 | The SCAN Foundation
Fact Sheet

On January 10, 2013, California Edmund G. Brown, Jr. released his proposed budget, outlining his spending plan for fiscal year beginning on July 1, 2013 and ending June 30, 2014. This fact, California's Proposed 2013-14 Budget: Impact on California's Seniors and People with Disabilties, looks at the initiatives and program adjustments that would impact California's seniors and people with disabilities.




Across the States 2012: Profiles of Long-Term Services and Supports

OCT 12, 2012 | AARP Public Policy Institute
In-Brief | Executive Summary | CA | Full Report (370 pgs)

From the AARP Public Policy Institute, Across the States 2012: Profiles of Long-Term Services and Supports presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single reference. The full report provides a comprehensive picture of long-term services and supports in each state.


Moving “Dual Eligibles” Into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People With Disabilities

OCT 10, 2012 | Center on Budget and Policy Priorities

As policymakers seek to reduce federal budget deficits, they may face proposals to reduce spending on low-income Medicare beneficiaries who also are eligible for Medicaid (the “dual eligibles”) by 1) requiring them to receive both their Medicare- and Medicaid-covered services through a single managed care plan that would operate under a contract with their state, and 2) imposing a cap on the funding their state would receive for that purpose. Such proposals would be ill-advised at this time.

Experts agree that we should try to find ways to better coordinate care for these beneficiaries that would improve quality of care while producing savings. But, as the report Moving "Dual Eligibiles" Into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People with Disabilities shows, we do not yet know how to do this.


Loneliness in older persons: a predictor of functional decline and death.

JUL 23, 2012 | | US National Library of Medicine, National Institutes of Health
Abstract | Perissinotto CM, Stijacic Cenzer I, Covinsky KE

Loneliness is a common source of distress, suffering, and impaired quality of life in older persons. We examined the relationship between loneliness, functional decline, and death in adults older than 60 years in the United States.

Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.


Medicaid Rate-Setting Strategies to Promote Home- and Community-Based Services

MAY 2012 | Center for Health Care Strategies (CHCS)
Policy Brief

In creating managed long-term services and supports approaches that foster home- and community-based services, states need to explore rate-setting strategies that reward health plans for promoting the use of such services. The brief, Medicaid Rate-Setting Strategies to Promote Home- and Community-Based Services, discusses strategies for structuring rates for managed long-term services and supports programs to encourage the use of home- and community-based services and details state experiences in setting rates for these programs.


A Tough Time for Physicians: 2012 Medical Practice & Attitude Report

MAY 24, 2012 | Jackson Healthcare

In A Tough Time for Physicians: 2012 Medical Practice & Attitude Report, Jackson's findings from a series of surveys conducted between May and June 2012 are summarized. Topics surveyed and included in this report:

  • Current practice environment (p 5)
  • Current retirement plans (p 7)
  • Current access for Medicaid and Medicare patients (p 10)
  • Current use of physician assistants and nurse practitioners (p 13)
  • Current participation in Accountable Care Organizations or Medical Homes (p 15)
  • Current attitudes on the Affordable Care Act (p 17)


The 2012-13 Budget: Integrating Care for Seniors and Persons With Disabilities

FEB 17, 2012 | Legislative Analyst's Office (LAO)

In a February 17, 2012 LAO report, The 2012-13 Budget: Integrating Care for Seniors and Persons With Disabilities, the Legislative Analyst found that it is premature to expand the Care Coordination Initiative demonstration statewide and make LTSS managed care benefits, since the demonstration has not yet been implemented—much less evaluated—and many key implementation details remain to be determined. The report recommends the Legislature reject the Governor’s proposal to expand the demonstration statewide before the results from the demonstration have been properly evaluated, but proceed instead with the four-county demonstration. Additional recommendations are made with the intent to help the state move toward a more integrated system of care delivery for SPDs.




Independence at Risk: Older Californians with Disabilities Struggle to Remain at Home as Public Supports Shrink

DEC 2011 | UCLA Center for Health Policy Research
Health Policy Brief

Researchers spent a year following and documenting the lives of a typical group of seniors with disabilities who are enrolled in Medicare and Medi-Cal and receive in-home and community care in Los Angeles, San Diego, San Francisco and Santa Clara counties. The seniors depend on fragile networks of paid public programs and unpaid help to live safely and independently at home. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost.


National Study of Long Term Care Providers

OCT 2011 | Centers for Disease Control and Prevention National Center for Health Statistics (CDC NCHS)

The National Study of Long-Term Care Providers (NSLTCP) is a new integrated initiative sponsored by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). The NSLTCP will replace the NCHS’ National Nursing Home Survey, National Home and Hospice Care Survey, and National Survey of Residential Care Facilities.

NCHS plans to field the residential care and adult day care components of NSLTCP in late 2012. Participants will be selected randomly from among all residential care communities and adult day services centers in the United States. The main goals of NSLTCP are to:

  1. Estimate the U.S. national supply of paid, regulated LTC providers (i.e., nursing home, home health care, residential care, adult day care, and hospice).
  2. Estimate key policy-relevant characteristics and practices of these providers.
  3. Estimate the use of these providers.
  4. Estimate key policy-relevant characteristics of these users.
  5. Monitor national trends in these estimates of LTC supply and use, overall and by provider type.


Medi-Cal Provider Payment Reductions in SPAs Approved by CMS

OCT 27, 2011 | CA Department of Health Care Services (DHCS)
Chart -- Medi-Cal Provider Payment Reductions

On October 27, 2011 the Centers for Medicare and Medicaid Services approved California’s request to reduce Medi-Cal reimbursement rates for providers of health care services. To view documents related to approval of the State Plan Amendment (SPA), visit:

Additional details about implementation of the retroactive 5% and 10% rate reductions for ADHC providers in urban areas of the state are not yet available from the state. The 5% rate reduction is currently enjoined by federal court order, but the new 10% rate reduction was approved by the California Legislature in March 2011 to be retroactive to June 1, 2011 and, therefore, is not currently part of any litigation proceedings. Also see: OCT 27, 2011 | CAADS Industry Alert.


A Study of Patient Discharge Outcomes Resulting from California's Elimination of Adult Day Health Care on December 1, 2011CAADS Report on ADHC Patient Discharge Outcomes

OCT 2011 | CAADS
Study Findings

CAADS surveyed ADHC providers for the purpose of analyzing overall services needed and services available for typical ADHC patients attending 4 or 5 days per week who will be involuntarily discharged from ADHC when Medi-Cal funding for the program ends December 1. The findings from A Study of Patient Discharge Outcomes Resulting from California's Elimination of Adult Day Health Care on December 1, 2011 - CAADS Report on ADHC Patient Discharge Outcomes, focus on:

  • Post-ADHC Discharge Prognosis
  • Multi-Disciplinary Team Recommendation for Discharge
  • Patient Needs
  • Services Needed / Available
  • Significant Risk Factors

In compliance with HIPAA, the ADHC Involuntary Discharge Form was developed as an e-form which transmitted the data without patient identifying information.


Stressed and Strapped: Caregivers in California

SEPT 21, 2011 | UCLA Center for Health Policy Research
Policy Brief

Family members or friends caring for aging or disabled individuals in California are under both financial and emotional strain and are likely to face even greater burdens, given recent cuts in state support for programs and services that support in-home care, according to the authors of a new policy brief, Stressed and strapped: Caregivers in California, by the UCLA Center for Health Policy Research.


Elimination of ADHC as a Medi-Cal Optional Benefit

JUN 2011 | CAADS
Survey Findings

CAADS surveyed California's ADHC providers on the impact the elimination of ADHC as a Medi-Cal optional benefit would have on their center, patients and community. The survey findings focus on:

  • Adult Day Health Care Providers Ability To Stay Open Without Medi-Cal Reimbursement
  • Nursing Facility Placements and Access to Medi-Cal Nursing Home Beds
  • Psychiatric Facility Placements and Access to Medi-Cal Psychiatric Beds
  • Consequences For Patients With Developmental Disabilities
  • Cost Shift to Emergency Rooms and Emergency Room Visits Over One Year
  • Consequences for IHSS Caregivers and Consequences for Working Caregivers
  • Availability of Alternative Services


Keeping Adults Free from Institutions (KAFI): Medicaid Options to Guide Program Design

MAY 10, 2011 | Health Management Associates (HMA)

The 2010-2011 California Legislature enacted AB 97 eliminating Adult Day Health Care as a Medi-Cal covered service. The legislature is instead proposing to transition individuals no longer eligible for ADHC services to other service options including California’s In-Home Supportive Services program, (which provides personal care and related services) or to existing home and community-based services (HCBS) waivers.


The Health of Aging Lesbian, Gay and Bisexual Adults in California

MAR 2011 | UCLA Center for Health Policy Research
Policy Brief

Members of California's aging lesbian, gay and bisexual population are more likely to suffer from certain chronic conditions, even as they wrestle with the challenges of living alone in far higher numbers than the heterosexual population, according to a new policy brief from the UCLA Center for Health Policy Research.


Getting Serious About Delirium: Hospitalists amp up screening, treatment and prevention

JAN 2011 | Today's Hospitalist
Article by Bonnie Darves

It is important for Adult Day Services providers to be able to distinguish delirium from Alzheimer's and related dementia. This article, Getting serious about delirium, covers how to prevent and treat delirium without meds and offers insights to those working in the community setting with high risk consumers.




Evaluation of the Parma D.A.Y. (Designed Around You) Program

JAN 2010 | Case Western Reserve University

Facilitating the safe transition of persons from the acute care hospital to home is a priority issue, given the frequency with which individuals are readmitted and/or visit the emergency department within 30 days of discharge. Many of these individuals require rehabilitation services, but reimbursement policy currently limits available options for continuing care. Furthermore, families may need more comprehensive education about health care needs of their family member, and home environments may need to be modified to ensure safety once the person returns home. One strategy for meeting these needs of patients and family members is an expanded adult day services program.


A New Nursing Home Population: The Young

DEC 9, 2010 | National Public Radio (NPR)
Investigative Report

There's one age group that's going into nursing homes at a higher rate. And it's not the elderly. Young people ages 31 to 64 now make up 14 percent of the nursing home population, an analysis of federal data from the Department of Health and Human Services by NPR's Investigative Unit found. That's up from 10 percent just 10 years ago.


Projected Economic Impact of Eliminating California's Medi-Cal Adult Day Health Care Program

MAY 18, 2010 | The Lewin Group

Our analysis indicates that the savings associated with eliminating this program would be more than offset by cost-shifting to other services and reductions to State revenue resulting from the program elimination. In total, we estimate the State would lose $51 million in 2010-11 over and above the estimated savings that would come from eliminating the program (excluding the loss of federal matching funds). Annual losses to the State are projected to increase to $72 million in 2020-21, $198 million in 2030-31 and over $412 million in 2040-41.


Budget Proposals Turn Back Clock 30 Years in Long-Term Care Services for California Seniors

FEB 2010 | UCLA Center for Health Policy Research
Policy Note

The 2010-2011 California budget proposal released in January by Governor Arnold Schwarzenegger’s office proposes deep cuts in community-based services available to low-income seniors and low-income Californians of all ages with disabilities. The cuts will make it much more difficult for many older adults to continue to live safely in their own homes, create hardships for their families, lead to a loss of jobs and health insurance by direct service providers, and close many adult day care centers. Increased use of emergency rooms, hospital in-patient care and nursing facilities by affected older adults are likely to erode the financial savings of the reductions.




California Budget Cuts Fray the Long-Term Care Safety Net

OCT 2009 | UCLA Center for Health Policy Research
Policy Brief

The deep budget cuts enacted by California’s legislature in the summer of 2009 will be felt especially among the elderly and infirm. Disabled older adults with low incomes will find it harder to access services and, ultimately, harder to live safely at home.




Adult Day Services: A Key Community Service for Older Adults

JUL 2006 | U.S. Dept of Health and Human Services, Office of Disability, Aging and Long-Term Care Policy (DALTCP)
Report by Janet O'Keeffe and Kristin Siebenaler

Adult day health services are part of the continuum of both health and long-term care services. In the states we visited, ADS providers are furnishing preventive care, health monitoring, and skilled nursing services to individuals with chronic illnesses and physical and cognitive impairments. Some providers are also serving adults under age 65, depending on regulatory requirements and the funding streams for this population.




Health of Older Californians: County Data Book

OCT 2003 | UCLA Center for Health Policy Research
County Data Book

Data from the 2001 California Health Interview Survey and 2000 U.S. Census

This data book provides important information about the health behaviors, health status, and the use of health services by Older Californians. The first section contains a narrative summary about the health of the older people in California. The second section has maps that show the distribution of the older population along several of the basic demographic characteristics used in this report, including race/ethnicity, low-income, and limited-English proficiency. The third section provides a series of two-page tables with the rates of selected health behaviors, the health status, and the use of health services of older Californians. Each geographic area has columns with information for elders of different races and ethnicities, older women, older people with low-incomes, older people with limited-English abilities, and for Medi-Cal recipients age 65 and over. This section ends with a summary table that makes comparisons between counties easier for the total county populations of older adults. The fourth section has demographic data for the state, substate regions, and each of the 58 counties. The fifth section contains technical appendices and acknowledgments.



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