Starting in January, California will embark on an ambitious experiment to control asthma in its most vulnerable patients. Medi-Cal will offer recipients unconventional in-home “treatments” not traditionally considered healthcare: removing mold, installing air purifiers and even replacing carpeting, blinds and mattresses.
The new asthma benefits are part of Gov. Gavin Newsom’s $6 billion initiative to transform the largest Medicaid program in the country. CalAIM will target the state’s sickest and most expensive patients and cover an array of new social services, including home-delivered healthy meals; help with grocery shopping, laundry and money management; and security deposits for homeless people in search of housing.
Newsom’s goal is to lower soaring Medi-Cal spending — which hit $124 billion this fiscal year — by preventing costly care such as emergency room visits. But state health officials acknowledge the new asthma benefits may not actually save taxpayer money.
Nor will the benefits be distributed equally: Because Medi-Cal managed-care insurance plans have immense power to decide which new services to offer and to whom, the initiative may create a patchwork of haves and have-nots.
Of the 25 participating insurance companies, 11 will offer the in-home asthma services starting in January in 36 of the state’s 58 counties. Within those counties, some Medi-Cal recipients will qualify; others will not.
With just two weeks to go before the program debuts, many insurers are scrambling to establish networks of nonprofit organizations and private contractors that specialize in delivering in-home asthma services and home repairs.
In San Bernardino and Riverside counties, for example, about 400 patients served by the Inland Empire Health Plan — out of nearly 1.4 million Medi-Cal plan members — will have access to asthma services in the first year, largely because the insurer has identified only one organization equipped to handle the responsibility. Most don’t have expertise in medical billing, patient privacy regulations and managed-care contracts.
California’s Medicaid director said earlier this year that health plans will start small but add capacity over the five years of the initiative. The state is offering incentive payments to help plans launch new services and has set aside $300 million for the first half of 2022 alone.
The Department of Health Care Services, which administers Medi-Cal, could not say how many low-income Californians will receive new in-home asthma services, because they are voluntary, and as a result could not predict future costs.
Anthony Cava, a department spokesperson, cited data showing that more than 220,000 Medi-Cal recipients have poorly controlled asthma. The state pays $200 to $350 for a typical asthma-related emergency room visit, and $2,000 to $4,000 a day for a typical inpatient hospitalization, department officials said.