Making CalAIM work for families struggling with Alzheimer’s

People want to take care of their loved ones. Caring for each other is at the core of being a family and central to the health and well-being of our state. However, conditions like Alzheimer’s dementia are often beyond what an individual family can manage by themselves. It’s something we must help each other address.

Good news – this work has gotten started. Gov. Gavin Newsom deserves credit for championing California’s Master Plan on Aging, which includes support for dementia and caregiver services. Former First Lady Maria Shriver’s work as Chair of the California Governor’s Task Force on Alzheimer’s Disease Prevention and Preparedness has raised needed awareness about families’ struggles.

Building from these and other initiatives, our Medi-Cal program now has new and potentially powerful benefits to help meet the needs of low-income Californians and their families striving to care for someone with dementia.

CalAIM (California Advancing and Innovating Medi-Cal) identifies people with complex and high-cost needs, such as dementia, and offers a package of services that starts with Enhanced Care Management (ECM) and Community Supports (CS). Enhanced care management includes referrals to needed community and social services and coordination of health and social care. Community supports can include respite care, home modifications, and home-delivered meals, depending on the needs of the person and the family.

All good? Not quite. Since enrollment started in January 2023, only 6,000 Californians in Cal-AIM’s ECM population of focus category “at risk of institutionalization” have received services.  Further, only half of those people are older adults. We know based on the prevalence of Alzheimer’s disease that this is a small fraction of the 75,000 to 150,000 older Medi-Cal beneficiaries who are likely eligible for ECM and CS because of dementia.

This under-enrollment creates challenges for providers, too. As of last October, health plans had contracted with more than 500 community-based organizations around the state to provide ECM for this group, but small caseloads threaten to force these essential organizations out of the program or out of business. Without enough clients, they can’t afford the staff they hired to enter the program. Their publicly funded start-up investments will be wasted if we can’t identify and refer many more people into the program.

To increase enrollment, we need to take immediate steps to make sure that eligible people and their families understand and can access what CalAIM offers:

Medi-Cal managed care health plans, state officials, and other stakeholders should come together to create referral and enrollment pathways that are realistic, responsive, and easy to access.

California’s In-Home Supportive Services program should help enroll clients in CalAIM, as almost a quarter of its participants are struggling with dementia.

California’s Caregiver Resource Centers, Aging and Disability Resource Centers, and many other Alzheimer’s support organizations get calls every day from people with dementia or their caregivers. They should all play a role in boosting referrals to CalAIM.

In short, we must work together quickly and effectively and get the word out to ensure this innovative program works as designed.

Meeting the complex and costly needs of a loved one with dementia is hard for anyone, but for people living on low incomes, the challenges can be overwhelming. It can lead to unwanted nursing home placements that break families apart and cost taxpayers more.

We don’t have a cure yet for dementia, but we do have a responsibility to help those living with the disease. CalAIM can make a big difference for these individuals and their families who are struggling to provide care. With this new program, if we use it, we can keep families together, improve care. and reduce costs.

Christopher A. Langston, PhD, is a caregiver for his aging parents and former president and CEO of Long Beach-based Archstone Foundation, committed to improving the health and well-being of older Californians and their caregivers.