CCHA Opposes Department's Proposed Expansion of "Whole Child Model"
California's Department of Health Care Services is proposing changes to state law that would shift case management and referral responsibilities for children with medical complexity to Medi-Cal managed care in 15 additional counties, starting in 2024.
Typically, the California Children's Services (CCS) Program operates alongside and in coordination with Medi-Cal managed care. When children are enrolled in both programs, the CCS Program coordinates care for the child's CCS medical condition and the child's Medi-Cal managed care plan manages the child's primary care services. In 2016, the Department of Health Care Services obtained legislative approval to incorporate CCS services into Medi-Cal managed care plan contracts in 21 predominantly rural counties. The Department argued that this change, which is called "Whole Child Model," would improve the coordination of primary and specialty care for children in CCS. The Department has recently completed an independent evaluation of the Whole Child Model, and it appears that the model has some problems. Chief among them is that some children with CCS eligible medical conditions are not being identified for services in Whole Child Model counties. In addition, families with children who need the most care report dissatisfaction with the approach. The model also results in cuts in Medi-Cal supplemental payments to children's hospitals. Despite these problems, the Department is proposing to expand the Whole Child Model into 15 additional counties, starting in January 2024. CCHA recently wrote a letter to California's budget committee leaders, opposing the Department's proposal.