Master Plan: 5 Bold Goals

Goal two for 2030
Goal two: Health Reimagined

"We will have access to the services we need to live at home in our communities and to optimize our health and quality of life."

Target: Close the Equity Gap in and Increase Life Expectancy

View Goal Two’s data indicators and track our progress at the Data Dashboard for Aging.

Health is a lifelong journey. To age well, from birth to 100-plus years old, all Californians need access to both health care and healthy communities across the lifespan. Tragically, the COVID-19 pandemic is laying bare the health impacts of systemic racism over a lifetime, with disproportionate deaths by Latino, Black, and Native Hawaiian and other Pacific Islander adults who are 60 and over. More than 7,700 people in these categories died of COVID-19 in 2020. Vaccine distribution centered on equity by age and by race, among other factors, is key to California’s response to the pandemic.

As we age, many adults find that the need to focus on health increases. Nearly half of all Californians will acquire one or more chronic illnesses. Nearly nine in ten older adults take at least one prescription drug, with one in four finding their costs to be unaffordable, even with insurance coverage. Older adults are also at particular risk for mental health issues, like depression. Access to health care at all ages is the foundation for healthy living and aging, and California leads the nation in health care coverage for older adults – most recently through the expansions of Medi-Cal and Covered California, California’s health exchange. Those still most at risk for not having access to comprehensive health care coverage include people with lower incomes, those living in rural areas, and those without citizenship status.

At the same time, services beyond health care are increasingly understood as essential to maintaining health and to aging well at home and in the community. For example, over half of older adults, especially women, will eventually need home care or adult day health care to assist with daily activities such as meal preparation, physical activity, and bathing. California’s In-Home Supportive Services is a national leader in this model of care.

As more Californians live longer lives, more people will seek home or community care to support optimal health and to continue to live well within homes and communities of choice. Critically, these services are often unaffordable for individuals, particularly for middle income older adults covered by Medicare only, which still largely does not cover these home and community services. To provide the care needed for optimal health and choice as we age, medical services and non-medical supports can be integrated and made accessible to people living both in home and in community. Ultimately, coordinated care between health plans and community organizations serving older adults and people with disabilities can improve lifelong health outcomes and life satisfaction.

Another byproduct of more Californians living longer is the need for more health care informed by geriatric expertise – yet only about 5 percent of providers have this training. California will need a larger health care workforce that is trained in geriatrics, including Alzheimer’s and all dementias, and is more representative of the diversity within California. Dementia’s growing impact requires urgent focus. The Governor’s Task Force on Alzheimer’s Prevention, Preparedness & Path Forward, led by the state’s former First Lady Maria Shriver, spotlighted the 690,000 Californians aged 65 and older living with Alzheimer’s Disease, a devastating illness with physical, emotional, and financial tolls that impacts not just those individuals, but also friends, families, caregivers, communities, and health systems.

For those adults requiring full-time health care, the COVID-19 pandemic has been a stark reminder of the vulnerability of Californians living and working in skilled nursing facilities (SNFs). While only 2 percent of our state’s population live in these facilities, they account for over a third of the pandemic death toll. Preliminary data suggest a significant minority of long-term care residents who died of COVID-19 in 2020 had dementia. California’s nursing homes can be national leaders in applying lessons learned and innovating new models of care for this most vulnerable population.

California will pursue Health Reimagined through the strategies and initiatives listed below.

Strategy A: Bridging Health Care with Home

Through innovative partnerships with the federal government, health plans, health systems, and community-based organizations, California can innovate and test new models of heath care delivery that maximize access to the services – and, as a result, avoid unnecessary institutionalization.

  • Initiative 33

    - Advocate with the new federal Administration to create a universal Long-Term Services and Supports benefit and assess opportunities for federal/state partnership (e.g., Milliman study, Washington State model). (Lead Agency: CHHS)
  • Initiative 34

    - Plan and develop innovative models to increase access to long-term services and supports for people receiving Medicare only. (Lead Agency: CHHS)
  • Initiative 35

    - Plan and develop innovative models to increase access to long-term services and supports and integrated health care for people receiving both Medicare & Medi-Cal (“duals”): by implementing statewide Managed Long-Term Services and Supports (MLTSS) and Dual Eligible Special Needs Plan (D-SNP) structure, in partnership with stakeholders. (Lead Agency: CHHS)
  • Initiative 36

    - Expand access to home and community-based services for people receiving Medi-Cal: via CalAIM, by implementing "In Lieu of Services" (including: Housing Transition Navigation Services, Housing Deposits, Housing Tenancy and Sustaining Services, Short-term Post Hospitalization Housing, Recuperative Care, Respite, Day Habilitation Programs, Nursing Facility Transition/Diversion to Assisted Living Facilities of Home, Personal Care and Homemaker Services, Home Modifications, Medically Tailored Meals, Sobering Centers, and Asthma Remediation) and "Enhanced Care Management." (Lead Agency: CHHS)
  • Initiative 37

    - Consider home and community alternatives to short-term nursing home stays for participants in Medi-Cal managed care through utilization of combination of the home health benefit, in lieu of services, and proposed expanded telehealth benefit, including remote patient monitoring. (Lead Agency: CHHS)
  • Initiative 38

    - Explore options within existing authority and new state plan authority for community health workers to conduct isolation checks/home visits for older and other adults, to meet need and as funds available. (Lead Agency: CHHS)
  • Initiative 39

    - Explore opportunities to increase stability for IHSS beneficiaries through back-up provider systems and registries. (Lead Agency: CHHS)
  • Initiative 40

    - Apply for federal funding to assess and plan for home and community-based services in all counties, with diversity of providers, via the anticipated federal planning grant to develop a Medi-Cal Home and Community Based Services Roadmap, in partnership with stakeholder process beginning 2020. (Lead Agency: CHHS)
  • Initiative 41

    - Assess need and opportunities to expand community-based aging and disability networks' "business acumen" for health partnerships. (Lead Agency: CHHS)
  • Initiative 42

    - Assess need and opportunities to modernize regulatory and licensing barriers for CBAS and MSSP. (Lead Agency: CHHS)
  • Initiative 43

    - Reformulate an LTSS aging and disability stakeholder group to advise on long-term services and supports for all older adults and people with disabilities, drawing on stakeholders with experience on MPA LTSS Subcommittee and Olmstead Advisory, as well as new members, with increased diversity and continued participation by older adults, people with disabilities, and care providers. (Lead Agency: CHHS)

Strategy B: Health Care as We Age

California can continue to lead the nation in pursuing strategies to increase access across the spectrum of health care services, including modernizing Medicare counseling services and developing new generic drug manufacturing partnerships, to improve access and care options.

  • Initiative 44

    - Modernize Medicare counseling services (HICAP) to serve more beneficiaries, continually improving cultural competency and language access, within existing resources. (Lead Agency: CHHS)
  • Initiative 45

    - Assess opportunities to modernize enrollment process for Medicare Savings programs. (Lead Agency: CHHS)
  • Initiative 46

    - Consistent with AB 80 (2020) when the DOF projects that the budget can accommodate the associated costs over a multiyear period, prioritize for inclusion in the budget the expansion of Medi-Cal to older adults who are undocumented. (Lead Agency: CHHS)
  • Initiative 47

    - Include older adult behavioral health needs and geri-expertise in Behavioral Health Task Force planning, beginning with CDA joining the Task Force. (Lead Agency: CHHS)
  • Initiative 48

    - Implement new generic prescription drug manufacturing partnerships for production or distribution, making essential medications affordable and accessible to more consumers – including older adults who are more likely to have a chronic condition requiring prescriptions and people with disabilities with co-occurring health conditions requiring prescriptions. (Lead Agency: CHHS)
  • Initiative 49

    - Highlight to Medi-Cal plans and providers the value of palliative care to improve patient outcomes and support patient and family choices for care. (Lead Agency: CHHS)
  • Initiative 50

    - Identify ways to promote care wishes – such as Advanced Planning Directives and Physician Orders for Life Sustaining Treatment – for all ages. (Lead Agency: CHHS)

Strategy C: Lifelong Healthy Aging

By fostering healthy environments beginning at birth, expanding access to prevention programs, and developing culturally competent public health educational tools and services, California communities can reduce some of the greatest and most inequitable health disparities.

  • Initiative 51

    - Share a series of public health/public education tools, with culturally competent and equity-targeted approaches, that promote brain health and address other healthy aging priorities (e.g., physical activity, nutrition, tobacco, oral health, mental health, substance abuse, and trauma). (Lead Agency: CHHS)
  • Initiative 52

    - Continue to seek federal funding for a friendship warmline for older adults to address isolation and loneliness needs, and partner with state departments who host crisis lines and access lines. (Lead Agency: CHHS)
  • Initiative 53

    - Build in older adult focus to existing Suicide Prevention Programs. (Lead Agency: CHHS)

Strategy D: Geriatric Care Expansion

California is home to some of the foremost geriatric experts in the country. Expanding Geriatric Emergency Department certification and increasing geriatric training opportunities will ensure our health care system is staffed by teams including geriatricians and gerontologists, as well as nurses and social workers with geriatric training.

  • Initiative 54

    - Diversify and align with aging demographics the pipeline of residents in clinical geriatrics, primary care, and geriatric psychiatry, including dementia care, through career incentive strategies such as workforce shortage and loan forgiveness programs. (Lead Agency: CHHS)
  • Initiative 55

    - Explore including geriatric training requirements, including dementia training, as well as racial and diversity demographics, via all state health licensing boards for new and continuing licensing. (Lead Agencies: CHHS & BCSHA)
  • Initiative 56

    - Include geriatric training in new community paramedic initiative. (Lead Agency: CHHS)
  • Initiative 57

    - Support expansion of geriatric emergency department certifications statewide. (Lead Agency: CHHS)
  • Initiative 58

    - Assess opportunities for advance practice providers trained in geriatrics to fill gaps in geriatrics and primary care. (Lead Agency: CHHS)
  • Initiative 59

    - Consider opportunities for gerontologists and geriatric social workers to participate in interdisciplinary teams. (Lead Agency: CHHS)
  • Initiative 60

    - Collect data on geriatric care provision to assess strengths and gaps, with equity metrics including race and disability (for example, dementia care, oral health). (Lead Agency: CHHS)
  • Initiative 61

    - Continue COVID-19 ad hoc geriatrics advisory group and broaden scope and participants in 2021 to include geriatric care expansion initiatives. (Lead Agency: CHHS)

Strategy E: Dementia in Focus

Continue California's leadership commitment to target clinical research into Alzheimer’s on gender and racial disparities. (lead Agency: California Health and Human Services Agency)

  • Initiative 62

    - Continue California's leadership commitment to target clinical research into Alzheimer's on gender and racial disparities. (Lead Agency: CHHS)
  • Initiative 63

    - Develop a plan for an equity-focused dementia-prevention public health campaign, to meet needs as funds available. (Lead Agency: CHHS)
  • Initiative 64

    - Promote screening, diagnosis, and care planning by health care providers for patients and families with Alzheimer's and related dementias, through hub and spoke training model of health care providers; direct caregiver training opportunities; and consideration of how dementia standards of care could be further incorporated in Medi-Cal and Medicare managed care. (Lead Agency: CHHS)
  • Initiative 65

    - Seek stakeholder feedback on models of care coordination for IHSS participants with dementia or cognitive impairment. (Lead Agency: CHHS)
  • Initiative 66

    - Assess options to increase Adult Day Services, especially for people with dementia. (Lead Agency: CHHS)
  • Initiative 67

    - Strategically plan and lead the growing number of California's pioneering Alzheimer's and all dementia initiatives with renewed leadership and partnership for the California Health and Human Services Agency Alzheimer's Advisory Committee beginning 2021. (Lead Agency: CHHS)

Strategy F: Nursing Home Innovation

California can emerge from the COVID-19 pandemic with renewed commitment to innovation in quality care, including such areas as value-based payment and architectural redesign to smaller, more home-like environments.

  • Initiative 68

    - Produce "COVID 2020" report on skilled nursing facilities and COVID-19, with California lessons learned and recommendations for national (CMS) policy reform. (Lead Agency: CHHS)
  • Initiative 69

    - Continue to expand transparency on state data on nursing homes, including quality, staffing, financing, both in COVID-19 and ongoing. (Lead Agencies: CHHS & LWDA)
  • Initiative 70

    - Reengage stakeholders to revisit pilot for "small house" nursing homes. (Lead Agencies: CHHS & LWDA)
  • Initiative 71

    - Explore additional value-based payment methodology changes in skilled nursing, focused on care quality, job quality, equity, and health outcomes. (Lead Agency: CHHS)
  • Initiative 72

    - Begin planning for growing skilled nursing and mental health needs in veterans’ homes, per the Veterans Home Master Plan of January 2020. (Lead Agency: CalVet)
  • Initiative 73

    - Begin planning for growing skilled nursing needs in custodial settings, including State Hospitals and correctional facilities, within existing resources. (Lead Agencies: CHHS & CDCR)
  • Initiative 74

    - Develop approach for patient representatives for residents of skilled nursing facilities without capacity, representatives, or written care wishes. (Lead Agency: CHHS)

Aging is a universal process throughout the lifespan and health shapes this experience, across physical, emotional, social, spiritual, and functional dimensions. Individuals age in the context of their multiple identities, influenced by our communities of belonging and the challenges and opportunities of our social and political world.

Fernando Torres-Gil, UCLA Luskin School of Public Affairs, SAC Member
/Content/images/Goals/inland empire healthplan partners

In communities across California, Partners in Care Foundation is promoting lifelong health and wellness through falls prevention and chronic disease self-management information and programs. In Riverside and San Bernardino Counties, Inland Empire Health Plan supports multidisciplinary and coordinated teams to ensure that older adults have access to member-centered LTSS systems that promote independent living.