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."

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 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 18

    - Continue to evaluate options for developing a Universal Long-Term Services and Supports (LTSS) benefit. Support research, data collection, and analysis of long-term services and supports financing for older adults and people with disabilities. This effort will supplement information provided by the Milliman feasibility study authorized by Provision 16 of Item 4260-101-0001 of the Budget Act of 2019 (Chs. 23 and 55, Stats. 2019) as well as the final Long-Term Care (LTC) Insurance Task Force report and actuarial dot image
  • Initiative 19

    - Develop a two-part Home and Community-Based Services (HCBS) Multiyear Roadmap. Each of these efforts seeks to improve access to HCBS services statewide, prioritizing planning for the development of programs for underrepresented populations and services in underserved areas of the state:

    - Medi-Cal HCBS and Managed LTSS Multiyear Roadmap: DHCS will oversee development of the Medi-Cal HCBS and Managed LTSS Multiyear Roadmap, which will be informed by the Medi-Cal HCBS Gap Analysis and the LTSS Data Dashboard.

    - Non-Medi-Cal HCBS Multiyear Roadmap: CDA will oversee development of the Non-Medi-Cal HCBS Multiyear Roadmap, which will be informed by the Non-Medi-Cal HCBS Gap Analysis.

    (Lead Agency: CalHHS)
  • Initiative 20

    - Finalize implementation of the federal Center for Medicare and Medicaid Services HCBS Settings Final Rules to protect the rights of Medi-Cal beneficiaries to receive HCBS services in settings that promote inclusion in the community and guard against isolation. (Lead Agency: CalHHS)green dot image
  • Initiative 21

    - Collect and analyze utilization data upon full implementation of CalAIM Enhanced Care Management and Community Supports to evaluate use by older adults and people with disabilities to ensure access to coordinated, whole-person care. (Lead Agency: CalHHS)green dot image
  • Initiative 22

    - Facilitate opportunities for community-based organizations to develop business acumen and organizational capacity to partner with managed care entities to ensure access to culturally responsive services for older adults and people with disabilities. (Lead Agency: CalHHS)green dot image
  • Initiative 23

    - Advance implementation of the California Community Transitions program and the Community Living Fund as key programs that allow older adults and people with disabilities to transition from institutional settings to the community and prevent institutionalization. (Lead Agency: CalHHS)green dot image
  • Initiative 24

    - Continue to expand access to the Medi-Cal Assisted Living Waiver, the Home and Community-Based Alternatives Waiver, the Program for All-Inclusive Care for the Elderly (PACE), Community-Based Adult Services (CBAS), and the Multipurpose Senior Services Program (MSSP). (Lead Agency: CalHHS)green dot image
  • Initiative 25

    - Support older adults who are transitioning to community living from incarceration or other secured settings, leveraging opportunities through CalAIM Enhanced Care Management and Community Supports as well as the Returning Home Well initiative to locate housing for older adult parolees who would otherwise be released without access to secure housing options. (Lead Agency: CalHHS)green dot image

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 26

    - Fully eliminate the Medi-Cal asset test by January 1, 2024, to help more older adults avoid impoverishment to qualify for Medi-Cal, accessing services and supports needed as they age. (Lead Agency: CalHHS)green dot image
  • Initiative 27

    - Subject to funding availability and federal approval, increase the Medi-Cal maintenance needs income level (after health care expenses) to 138 percent of the Federal Poverty Limit (FPL) (currently around $1,500 per month) beginning in 2025 (per provisions included in the 2022-23 Budget Act). (Lead Agency: CalHHS)green dot image
  • Initiative 28

    - Improve health care affordability and reduce delays in coverage for older adults and people with disabilities through Medicare and Medi-Cal changes to be implemented under federal regulations tied to the Consolidated Appropriations Act of 2021. (Lead Agency: CalHHS)green dot image
  • Initiative 29

    - Advance the statewide goals of better integrating, coordinating, and aligning services across the Medicare and Medi-Cal programs for California’s dual eligible beneficiaries. (Lead Agency: CalHHS)green dot image
  • Initiative 30

    - Convene Medicare Advantage plans in partnership with the Centers for Medicare and Medicaid Services (CMS) to explore innovative strategies and common goals to improve quality, access, affordability, and equity for Medicare beneficiaries in California. (Lead Agency: CalHHS)green dot image
  • Initiative 31

    - Partner with the Mental Health Services Oversight and Accountability Commission (MHSOAC) to expand the Program to Encourage Active Rewarding Lives for Seniors (PEARLS) evidence-based behavioral health program to reach more older adults in more California communities and bring the innovative AgeWise model to scale for replication statewide. (Lead Agency: CalHHS, MHSOAC)green dot image
  • Initiative 32

    - Focus on risk reduction and prevention strategies based on data reported by the California Violent Death Reporting System (VDRS) to address individuals most at risk of suicide, including older adults aged 85 and above who experience the highest suicide rates statewide. (Lead Agency: CalHHS)green dot image

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 33

    - Identify promising practices in collaboration with public/private partners that promote lifelong healthy aging and brain health, while maximizing independence and community integration. (Lead Agency: CalHHS)green dot image
  • Initiative 34

    - Examine, with an equity lens, available data to determine the consequences of long-term COVID-19 on older adults and people with disabilities to develop sustainable services and supports. (Lead Agency: CalHHS)green dot image
  • Initiative 35

    - Commit to a robust rollout of the Physician Orders for Life-Sustaining Treatment (POLST) registry to include consumer education, provider training, streamlined workflows, and technology support. (Lead Agency: EMSA, OSI)green dot imagegreen dot image
  • Initiative 36

    - Include palliative care services for members with serious illness in model contract language for Medicare Advantage Dual Eligible Special Needs Plans. (Lead Agency: CalHHS)green dot image
  • Initiative 37

    - Lead statewide, regional, and local COVID-19 vaccination initiatives to keep at-risk populations current with their vaccine and booster series through targeted paid media, earned media, strategic partnerships, and community outreach to focus on equitable access for Californians most at risk of COVID-19 infection, including older adults, people with disabilities, Latinos, and Blacks. (Lead Agency: CalHHS, OCPSC)green dot image

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 38

    - Expand opportunities for pipeline, stipends, tuition assistance, and loan forgiveness to undergraduate, graduate, and professional students to encourage academic and clinical focus on geriatrics, gerontology, and behavioral health. (Lead Agency: CalHHS)green dot image
  • Initiative 39

    - Map the statewide distribution of accredited Geriatric Emergency Departments (GEDs), prioritizing expansion to underserved areas, including rural communities and Veteran’s Affairs Medical Centers. (Lead Agency: CalHHS)green dot image
  • Initiative 40

    - Promote Age-Friendly Health System principles and encourage adoption of evidence-based practices to align with what matters most to older adults and their families, including in the Veteran’s Affairs network. (Lead Agency: CalHHS)green dot image
  • Initiative 41

    - Develop and implement programs specific to care of the incarcerated aging and disabled population. (Lead Agency: CDCR)green dot image
  • Initiative 42

    - Expand treatment services and placement options for the aging population served by the state hospital system. (Lead Agency: CalHHS)green dot image

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 43

    - Improve access to the Alzheimer’s Day Care Resource Center (ADCRC) model for rural and disproportionately impacted communities by leveraging the Cal-COMPASS Learning Community. (Lead Agency: CalHHS)green dot image
  • Initiative 44

    - Replicate best practices developed as part of California’s Healthy Brain Initiative and Blue Zone® efforts to extend statewide expertise in cultural competence, community outreach, caregiver education, workforce development, and local planning for people at risk of developing Alzheimer’s, individuals with dementia, and family caregivers. (Lead Agency: CalHHS)green dot image
  • Initiative 45

    - Continue to improve the dementia assessment and diagnostic process through California’s innovative Dementia Care Aware program developed to train more primary care providers who serve older adults, including people with Down Syndrome. (Lead Agency: CalHHS)green dot image

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 46

    - Monitor implementation of the statewide transition to Medi-Cal managed long-term care (nursing home care) to assess impacts on older adults and people with disabilities. (Lead Agency: CalHHS)green dot image
  • Initiative 47

    - Improve nursing home quality for older adults and people with disabilities by reforming the financing methodology for Skilled Nursing Facilities as outlined in AB 186 (Chapter 46, Statutes of 2022) the Medi-Cal Long-Term Care Reimbursement Act, to incentivize and hold facilities accountable for staffing levels and quality resident care, working with consumer advocates, providers, and labor unions to establish the methodology, parameters, and eligibility criteria. (Lead Agency: CalHHS)green dot image
  • Initiative 48

    - Implement the Veterans Home master plans to continue to provide premier care and services at eight state facilities across California.(CalVet)green dot image
  • Initiative 49

    - Ensure resident rights, individual preferences, and cultural values are considered to mitigate transfer trauma by evaluating best practices and developing a protocol for facility closures. (Lead Agency: CalHHS)green dot image
  • Initiative 50

    - Promote the availability of the Cal Long-Term Care Compare website as a no-cost, objective, transparent, public resource designed to be an accessible, user friendly, and easy to navigate source of nursing home quality data. (Lead Agency: CalHHS)green dot image
  • Initiative 51

    - Reduce or prevent social isolation among nursing home residents in the event of future public health emergencies by addressing the concerns of residents and family members. Develop recommendations that balance public safety with the benefits of social engagement, personal connection, and community support. (Lead Agency: CalHHS)green dot image

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

In 2023-2024, California will advance ninety-five new Master Plan for Aging initiatives, building upon the work of the plan’s first two years. Each initiative features a designated area of focus:
blue dot image Deliver
orange dot imageAnalyze
green dot imageCommunicate

For a list of the 2021-2022 Initiatives, please view the original Master Plan for Aging report or the 2021 MPA Initiatives Progress Report.

/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.