Access to Medi-Cal's Long-Term Care Services Falls Short

Only 16% Medi-Cal recipients estimated to be eligible for Community-Based Adult Services were served by the program in 2020.

Two Medi-Cal long-term care programs designed to keep seniors and disabled adults out of nursing homes are serving only a fraction of the eligible population, a UCLA Center for Health Policy Research study finds.

The study found high potential demand across the state for services offered by Medi-Cal's Multipurpose Senior Services Program, which provides health and social services for people 65 and older who would otherwise require institutional care, and Community-Based Adult Services, which provide professional care at licensed adult day health centers in the community for disabled people and others at risk of institutionalization.

However, only about 39,000, or 16%, of the roughly 243,400 Medi-Cal recipients estimated to be eligible for Community-Based Adult Services were served by the program in 2020, the study found. 

Demand will only grow in coming years, with the need for such services increasing through 2025 and 2030 and into 2050, when people 65 and older are expected to make up some 25% of California's population, according to the study.

"Supportive programs provided to older adults and adults with disabilities at home and in the community are essential to maintaining physical and mental health," says Kathryn Kietzman, director of the center's Health Equity Program. "As the state continues to implement its Master Plan for Aging​, it is critical that gaps in access to long-term services and supports are addressed."

The researchers also found wide disparities by race and ethnicity, age, and geography in the proportion of people estimated to be eligible and those currently receiving these long-term services and support.

Among the study's findings:

• 106,700 people were estimated to be eligible for the Multipurpose Senior Services Program in 2020 — almost 10 times more than the 10,324 people served.
   
• Among those estimated to be eligible for Community-Based Adult Services, Black Americans and those who identified as two or more races were among the least likely to be receiving services, at 4% and 5%, respectively.
   
• Older Asian and Black adults were among the groups most underserved by the Multipurpose Senior Services Program. 
   
• All of California's geographic regions had significantly more people who were potentially eligible for both Community-Based Adult Services and the Multipurpose Senior Services Program than actually used them.
   
• Los Angeles County served 38% of those potentially eligible for Community-Based Adult Services in 2020, while other Southern California regions, taken together, served 10%.
   
• The lowest rates of participation in Community-Based Adult Services were seen in the Northern and Sierra region (2%) and the San Joaquin Valley (3%).
   
• The greatest participation in the Multipurpose Senior Services Program was observed in the Northern and Sierra (65%) and Central Coast (38%) regions.

"Our hope is that these findings will inform and prioritize the implementation of strategies to increase access to care," Kietzman says. "Ideally, program planners and providers will find ways to improve communication about available programs, ease pathways to program information and enrollment, and streamline eligibility requirements."