Less than 2 percent of the homes in Santa Barbara County are vacant.
This makes it extremely challenging to find rentals for anyone, especially those experiencing homelessness, said Sylvia Barnard with Good Samaritan Shelter.
“We find that for anyone experiencing homelessness, it’s over 120 days to get into housing,” Barnard said. “Having the resources available for housing retention once they get there is huge because they can prevent an individual from falling back into homelessness.”
To provide a better support, California has been experimenting with pilot programs since 2018 to connect housing, mental health, and medical services under one umbrella. In January, the state launched California Advancing and Innovating in Medi-Cal (CalAIM), an initiative that helps homeless individuals navigate housing, social, and health services through a case management program, and it allows all providers to be reimbursed by insurance claims.
Santa Barbara County joined CalAIM in July—its first time providing wraparound services after not being part of the pilot programs—and could be eligible for more than $19 million in state funding. County officials and nonprofit leaders believe the program is a step in the right direction, but they see low vacancy rates, minimal low-income housing, and beginning a completely new program as challenges.
Good Samaritan Shelter is one of the organizations joining CalAIM and recently contracted with CenCal, Medi-Cal’s Central Coast insurance provider. Executive Director Barnard said any of Good Sam’s case management, recuperative care, and housing services qualified under CalAIM can be reimbursed through filing a claim similar to other medical providers.
“It will enhance our ability to provide those services, and we are excited about the fact that it will create additional funding streams and stabilize the programs we have in place,” Barnard said.
The challenge is transitioning from a grant-based funding model to insurance reimbursements, she said. Good Sam will serve 100 percent Medi-Cal and CenCal members—a very large population in the county. The nonprofit will need to hire a full-time person just to manage the billing for these services in order to get reimbursed, a CalAIM coordinator to focus on the initiatives and requirements, and a case manager coordinator for the CalAIM’s Enhanced Care Management program.
“We are becoming a medical provider for insurance,” Barnard said. “It’s a transition period, and [we’re] making sure we have the right infrastructure. We’re excited about the possibility, but we have to have the capacity to make sure we do it right.”
Santa Barbara County received $6.4 million to kick off the project this year, CenCal Health Chief Health Equity Officer Van Do-Reynoso said. The county can earn up to $19.4 million in state funding if it meets the state’s infrastructure, provider capacity, and quality of service metrics.
Although data isn’t yet available to demonstrate CalAIMs success, Do-Reynoso said she feels very optimistic about the program and its continuation. Right now, the state budget has it set to continue through 2024.
“I think CalAIM is revolutionary. It’s intended to transform the way that we as a society are caring for our Medi-Cal members,” she said.
State funding will provide resources to current and prospective case management and community support providers to deliver a “person-centered, community-based” approach to people with complex health needs and unmet social needs, Do-Reynoso said.
“These individuals are at high risk of hospitalization, institutionalization, and other high-cost services,” Do-Reynoso said. “Enhanced care management and community supports are critical because we as a community need to support our providers with additional resources so they can build their capacity and infrastructure to provide services to our most vulnerable community members.”
There’s a larger intersection between health care and homelessness than many people realize, PATH Chief Regional Director Jonathan Castillo said.
PATH is a statewide nonprofit dedicated to resolving homelessness and was part of a 2017 California pilot program, Whole Person Care, serving San Diego. PATH’s San Diego branch transitioned to CalAIM at the beginning of the year to continue community support services, like housing navigation and assistance with rental deposits.
Since CalAIM’s start on Jan. 1, 2022, PATH has served 234 clients with 125 clients currently enrolled, according to PATH data. Sixty-eight of the 109 who are no longer enrolled made their way into permanent housing and switched to another provider.
“I know that in Whole Person Care, a lot of communities operationalized that differently. San Diego chose to target people who were unsheltered and high users of the health care system,” Castillo said. “It helped us get into a good position because [CalAIM] was basically a continuation of what we’ve been doing.”
San Diego’s two largest hospitals see 55 to 75 homeless individuals a day, and during Whole Person Care’s first year, PATH and its partners received 1,800 referrals from hospitals and medical providers, Castillo said.
“What the data showed is that 30 percent of the referrals were individuals that had a history of homelessness but never touched the homeless system. What that told us is there’s a lot of people the health care system is interacting with that the homeless system is not,” he said. “I think in many communities, with what we’ve seen, there needs to be a pathway from hospitals to interim housing sites.”
Having a team of people from multiple service points who interacted with one another allowed the client to transition smoothly from the medical sector to homeless services, Castillo said. Historically, providers were limited in their scope of service, allowing for individuals to slip through the cracks during the handoff between medical or behavioral health care to shelter services or housing navigation.
However, it’s still a challenge to hire the right number of staff and develop enough caseloads to obtain the funding necessary to enact CalAIM, said Glen Hilton, PATH director of community care.
“I think it’s imperative that providers going into this have a lot of clarity that there will be a time investment they need to make,” Hilton said. “In addition to cost, there may be some time they need to get back and break even.”
PATH had challenges hiring enough case managers during Whole Person Care to grow enough revenue to hire more staff and support the program—coming into CalAIM for the first time could put some organizations in “compromising positions,” with high start-up costs and the need to over-hire, he said. However, low vacancy rates and high demand demonstrate the need for a program like this.
“The access that is provided through CalAIM is a huge factor. Prior to CalAIM, the majority of our programs that assist with housing and navigation are limited-source programs where they have to be approved by a particular funder; that doesn’t allow for universal access,” Hilton said. “[CalAIM] allows [individuals experiencing homelessness] to have the support they need to find housing and shelter and to make it easier to survive until that time comes.”
Staff Writer Taylor O’Connor can be reached at toconnor@santamariasun.com.
This article appears in Dec 1-8, 2022.