CaliforniaS $12 billion Medicaid makeover banks on nonprofits buy-in

Published

2 years ago

May 16, 2024

admin

May 16 2024 KFF Health News

For much of his young life, Jorge Sanchez regularly gasped for air, at times coughing so violently that he'd almost throw up. His mother whisked him to the emergency room late at night and slept with him to make sure he didn't stop breathing.

"He's had these problems since he was born, and I couldn't figure out what was triggering his asthma," Fabiola Sandoval said of her son, Jorge, now 4. "It's so hard when your child is hurting. I was willing to try anything."

In January, community health workers visited Sandoval's home in Turlock, a city in California's Central Valley where dust from fruit and nut orchards billows through the air. They scoured Sandoval's home for hazards and explained that harsh cleaning products, air fresheners, and airborne dust and pesticides can trigger an asthma attack.

The team also provided Sandoval with air purifiers, a special vacuum cleaner that can suck dust out of the air, hypoallergenic mattress covers, and a humidity sensor — goods that retail for hundreds of dollars. Within a few months, Jorge was breathing easier and was able to run and play outside.

The in-home consultation and supplies were paid for by Medi-Cal, California's Medicaid health insurance program for low-income residents. Gov. Gavin Newsom is spearheading an ambitious $12 billion experiment to transform Medi-Cal into both a health insurer and a social services provider, one that relies not only on doctors and nurses, but also community health workers and nonprofit groups that offer dozens of services, including delivering healthy meals and helping homeless people pay for housing.

These groups are redefining health care in California as they compete with businesses for a share of the money, and become a new arm of the sprawling Medi-Cal bureaucracy that serves nearly 15 million low-income residents on an annual budget of $158 billion.

But worker shortages, negotiations with health insurance companies, and learning to navigate complex billing and technology systems have hamstrung the community groups' ability to deliver the new services: Now into the third year of the ambitious five-year experiment, only a small fraction of eligible patients have received benefits.

"This is still so new, and everyone is just overwhelmed at this point, so it's slow-going," said Kevin Hamilton, a senior director at the Central California Asthma Collaborative.

The collaborative has served about 3,650 patients, including Sandoval, in eight counties since early 2022, he said. It has years of experience with Medi-Cal patients in the Central Valley and has received about $1.5 million of the new initiative's money.

By contrast, CalOptima Health, Orange County's primary Medi-Cal insurer, is new to offering asthma benefits and has signed up 58 patients so far.

"Asthma services are so difficult to get going" because the nonprofit infrastructure for these services is virtually nonexistent, said Kelly Bruno-Nelson, CalOptima's executive director for Medi-Cal. "We need more community-based organizations on board because they're the ones who can serve a population that nobody wants to deal with."

Newsom, a Democrat in his second term, says his signature health care initiative, known as CalAIM, seeks to reduce the cost of caring for the state's sickest and most vulnerable patients, including homeless Californians, foster children, former inmates, and people battling addiction disorders.

In addition to in-home asthma remediation, CalAIM offers 13 broad categories of social services, plus a benefit connecting eligible patients with one-on-one care managers to help them obtain anything they need to get healthier, from grocery shopping to finding a job.

The 25 managed-care insurance companies participating in Medi-Cal can choose which services they offer, and contract with community groups to provide them. Insurers have hammered out about 4,300 large and small contracts with nonprofits and businesses.

So far, about 103,000 Medi-Cal patients have received CalAIM services and roughly 160,000 have been assigned personal care managers, according to state data, a sliver of the hundreds of thousands of patients who likely qualify.

"We're all new to health care, and a lot of this is such a foreign concept," said Helena Lopez, executive director of A Greater Hope, a nonprofit organization providing social services in Riverside and San Bernardino counties, such as handing out baseball cleats to children to help them be active.

Tiffany Sickler runs Koinonia Family Services, which offers California foster children mental health and other types of care, and even helped a patient pay off parking tickets. But the program is struggling on a shoestring budget.

"If you want to do this, you have to learn all these new systems. It's been a huge learning curve, and very time-consuming and frustrating, especially without adequate funding," she said.

Brandon Richards, a Newsom spokesperson, defended CalAIM, saying that it was "on the cutting edge of health care" and that the state was working to increase "awareness of these new services and support."

For nonprofits and businesses, CalAIM is a money-making opportunity — one that top state health officials hope to make permanent. Health insurers, which receive hefty payments from the state to serve more people and offer new services, share a portion with service providers. Related StoriesStudy links higher-potency cannabis use in youth to increased risk of psychotic experiencesUncovering the psychological toll of entrenched school practices on childrenClinical trial in Seattle aims to transform treatment approaches for pediatric IBD

In some places, community groups are competing with national corporations for the new funding, such as Mom's Meals, an Iowa-based company that delivers prepared meals across the United States.

Mom's Meals has an advantage over neighborhood nonprofit groups because it has long served seniors on Medicare and was able to immediately start offering the CalAIM benefit of home-delivered meals for patients with chronic diseases. But even Mom's Meals isn't reaching everyone who qualifies, because doctors and patients don't always know it's an option, said Catherine Macpherson, the company's chief nutrition officer.

"Utilization is not as high as it should be yet," she said. "But we were well positioned, because we already had departments to do billing and contracting with health care."

Middleman companies also have their eye on the billions of CalAIM dollars and are popping up to assist small organizations to go up against established ones like Mom's Meals. For instance, the New York-based Nonprofit Finance Fund is advising homeless service providers how to get more contracts and expand benefits.

Full Circle Health Network, with 70 member organizations, is helping smaller nonprofit groups develop and deliver services primarily for families and foster children. Full Circle has signed a deal with Kaiser Permanente, allowing the health care giant to access its network of community groups.

"We're allowing organizations to launch these benefits much faster than they've been able to do and to reach more vulnerable people," said Camille Schraeder, chief executive of Full Circle. "Many of these are grassroots organizations that have the trust and expertise on the ground, but they're new to health care."

One of the biggest challenges community groups face is hiring workers, who are key to finding eligible patients and persuading them to participate.

Kathryn Phillips, a workforce expert at the California Health Care Foundation, said there isn't enough seed money for community groups to hire workers and pay for new technology platforms. "They bring the trust that is needed, the cultural competency, the diversity of languages," she said. "But there needs to be more funding and reimbursement to build this workforce."

Health insurers say they are trying to increase the workforce. For instance, L.A. Care Health Plan, the largest Medi-Cal insurer in California, has given $66 million to community organizations for hiring and other CalAIM needs, said Sameer Amin, the group's chief medical officer.

"They don't have the staffing to do all this stuff, so we're helping with that all while teaching them how to build up their health care infrastructure," he said. "Everyone wants a win, but this isn't going to be successful overnight."

In the Central Valley, Jorge Sanchez is one of the lucky early beneficiaries of CalAIM.

His mother credits the trust she established with community health workers, who spent many hours over multiple visits to teach her how to control her son's asthma.

"I used to love cleaning with bleach" but learned it can trigger breathing problems, Sandoval said.

Since she implemented the health workers' recommendations, Sandoval has been able to let Jorge sleep alone at night for the first time in four years.

"Having this program and all the things available is amazing," said Sandoval, as she pointed to the dirty dust cup in her new vacuum cleaner. "Now my son doesn't have as many asthma attacks and he can run around and be a normal kid."

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism. Source:

KFF Health News

Politics

Left-wing Labour MPs split on Angela Rayner’s future amid leadership speculation

Published

2 hours ago

December 12, 2025

admin

Left-wing Labour MPs split on Angela Rayner's future amid leadership speculation

Left-wing Labour MPs are split on whether they would welcome an Angela Rayner leadership bid, as speculation continues over whether Sir Keir Starmer can survive.

Senior MPs on the left have told Sky News that the former deputy prime minister “only needs to push the button” and she would have the support to take out her old boss.

But others said it “won’t wash with the public”, given it was only a few months ago that she resigned in scandal over her tax affairs. She has also been accused of not doing enough for the left while she was in government.

Sir Keir has insisted he would face down any threat to his leadership, while Ms Rayner’s allies say she has no plan to oust him.

But many MPs have said privately – if not publicly – that a challenge to his position appears increasingly inevitable given the state of the polls.

One MP in the socialist campaign group (SCG) said “all Angela needs to do is push the button” and MPs would get behind her – citing her popularity with the Labour membership.

Another MP said: “I think she would have a healthy number of people who would back her.”

Ms Rayner, a former trade union rep, was elected by members to be deputy Labour leader in 2020. She was a longstanding member of Jeremy Corbyn’s shadow cabinet and is revered by many of her colleagues on the left for her rise from a working-class background to the top of British politics, having left school at 16, pregnant, and with no qualifications.

However one MP said while they personally “rate her a lot” she “could have done more” for the left while in government.

“Ange was the deputy leader for a long time. I have to say she went to ground for a long time and didn’t speak up. Whether she has the support of MPs or the country I don’t know.”

This view was echoed by another colleague, who said she is “complicit” in the government’s failures.

This MP, in a traditional red wall seat, said the “visceral dislike of Starmer is baked in” and they have never experienced anything like the anti-Labour sentiment they are hearing on the doorstep.

They said any change of leader would have to be an outsider with a radical vision “like 1945”. “It would have to be Andy”, they said, referring to the Greater Manchester metro mayor Andy Burnham.

‘Burnham is a no-brainer’

Many MPs on both the left and the so-called “soft-left” told Sky News he would be their preferred candidate, given he is not associated with the current government, he has a different vision for the country and is popular with the public.

Mr Burnham is not currently an MP but he has not ruled out standing if a seat became available.

“In a hypothetical universe where all the barriers are overcome then Burnham is a no-brainer,” said one MP from the 2024 intake.

Another MP supportive of a Burnham takeover said a Rayner return “won’t wash with the public” given she had to resign from the second most senior position in government for underpaying stamp duty in September. They said it also wouldn’t be credible for her to “suddenly” start criticising the direction of the Starmer government given she was so closely tied to it.

As another MP put it: “I’d be backing a candidate from the left of the party. Angela Rayner is not from the left of the party.”

Other runners and riders

Any challenger would need the public backing of 80 colleagues to trigger a leadership contest. May is seen as crunch date if the local elections go as badly as predicted.

Other names that have come up include Health Secretary Wes Streeting and Home Secretary Shabana Mahmood. Mr Streeting is seen as a charismatic communicator who could take on Nigel Farage and Zack Polanski, while MPs within the “blue Labour” caucus are impressed with Ms Mahmood’s hard line on immigration.

But MPs on the left feel this would only offer a temporary boost in the polls as the pair are both seen as being on the centre-right, and a change of leader would be pointless without a change of direction.

Another name that has come up is the former Labour leader Ed Miliband, but while he is more to the left he has been rejected by the public once – having lost the 2015 election.

‘No active plot’

The MPs who spoke to Sky News stressed there was no active plot, but rather a general consensus that it is looking increasingly likely Sir Keir won’t be able to turn things around.

MPs who disagree with the prime minister’s politics said they are surprised at how personally disliked he is on the doorstep as he is ultimately a “nice man”.

They fear he has lost the trust of the public by saying one thing and doing another, with the winter fuel fiasco still coming up in areas where Reform UK is making gains.

As one MP put it: “We want him [Sir Keir] to do well and do better… but you can’t go on forever if things look terrible in the opinion polls.”

👉Listen to Politics at Sam and Anne’s on your podcast app👈

‘Budget has sparked a sea-change’

MPs have recently revived the soft-left tribune group with the aim of influencing the government to take more of a progressive direction.

Ms Rayner addressed this group on Tuesday night, along with new deputy leader Lucy Powell and cabinet ministers Mr Miliband and Lisa Nandy.

One MP who spoke to Ms Rayner said she has “absolutely no plans” to launch a leadership bid “unless she is keeping it quiet”. They added that the subject of a leadership challenge didn’t come up in any of the speeches and there was an “upbeat atmosphere” following the lifting of the two-child benefit cap.

“The budget has landed well with the party,” they said. “[The meeting] felt like a sea change.”

As deputy prime minister and housing secretary, Ms Rayner introduced the Employment Rights Bill within 100 days and pushed through reforms to renters rights, the leasehold system and further devolution. She is also said to have played a crucial role in persuading Sir Keir to water down welfare cuts in the face of a major backbench rebellion.

A source close to her defended her record, saying she is “not interested in pacts and plots” and wants the government to succeed. They said she is not finished in politics but “she’s no one’s pawn, she’s her own person”.

Ms Rayner resigned after an ethics investigation found she acted in good faith, but broke the ministerial code by failing to get the correct tax advice after purchasing a flat in Brighton. She referred herself to HMRC and an investigation is ongoing.

Sir Keir has said he wants her back in cabinet, a view echoed by many senior colleagues.

Politics

Nigel Farage’s former school responds to claims he made racist comments as a student

Published

2 hours ago

December 12, 2025

admin

Nigel Farage's former school responds to claims he made racist comments as a student

Dulwich College has said allegations that Nigel Farage made racist and antisemitic comments to fellow pupils at the school are “profoundly distressing” and “entirely at odds with the Dulwich College of today”.

In the first reported statement from the school about the accusations – which date from 1970s – current master Robert Milne wrote “such behaviour is wholly incompatible with the values the College holds”.

“What we can unequivocally state is that the behaviours described are entirely at odds with the Dulwich College of today,” he continued

The comments come in a letter to former Dulwich pupil Jean-Pierre Lihou.

Mr Lihou, 61, has alleged the current Reform UK leader sang antisemitic songs to Jewish schoolmates and “had a big issue with anyone called Patel”.

Mr Farage has said he “never directly racially abused anybody” at Dulwich and said there is a “strong political element” to the allegations coming out 49 years later.

Reform’s deputy leader Richard Tice has called the ex-classmates “liars”.

Nigel Farage said: “I have not met or spoken to this master. So I am surprised by his uninformed comments in response to claims from nearly 50 years ago from politically motivated actors.

“If he is interested, I can show him the many messages that I have received from fellow pupils, including Jewish ones, that entirely contradict these allegations.”

A spokesperson for Reform UK said: “This witch hunt is merely an attempt to discredit Reform and Nigel Farage.

“Instead of debating Reform on the substance of our ideas and policies, the left-wing media and deeply unpopular Labour Party are now using 50-year-old smears in a last act of desperation.

“The British public see right through it.”

The letter also says the college has avoided making any public statements “to protect the college’s reputation in the long term”.

“This should not be interpreted as indifference: safeguarding the college’s good name and upholding its values are of paramount importance to us,” it continues.

Mr Lihou told Sky News he cautiously welcomed the letter written to him from the master and said he understands why the college wasn’t willing to unequivocally condemn the allegations against the Reform leader directly.

“Dulwich College has been clear that such accusations are very much at odds with the values of the school,” he said.

He added: “Why can Mr Farage not accept that approaching 30 people [who] have lasting memories from him as a 13-year-old to an adult that he should unreservedly apologise for?”

Sky News has contacted Dulwich College for a comment.

World

‘What will hold back the Russians?’ Zelenskyy responds to new US peace proposal for Ukraine

Published

2 hours ago

December 12, 2025

admin

'What will hold back the Russians?' Zelenskyy responds to new US peace proposal for Ukraine

Volodymyr Zelenskyy says the US has offered to create a “free economic zone” in the contested Donbas region of eastern Ukraine in a bid to push a peace deal over the line.

The Donbas – an industrial and coal-mining area primarily made up of the Donetsk and Luhansk regions – has become one of the key sticking points in the US-proposed peace plan.

The first draft of the plan, widely leaked last month, stipulated that Ukraine must withdraw from areas of the Donbas it currently controls, thought to be a minority portion, as a condition for peace.

Ukraine considered that point “unacceptable”, and Mr Zelenskyy has spent the last few weeks drafting a response to the plan that removed “obvious anti-Ukraine points”.

After a series of meetings with Ukraine’s European allies, including a trip to London to meet Sir Keir Starmer on Monday, Zelenskyy said on Thursday that he’d sent Washington a revised peace plan, whittled down to just 20 points.

The new US proposal envisions Ukraine withdrawing from its territory in the Donbas without the Russians advancing, creating a neutral zone.

But Zelenskyy poured cold water on the plans as he briefed journalists in Kyiv.

“Who will govern this territory, which they are calling a ‘free economic zone’ or a ‘demilitarised zone’ – they don’t know,” he said.

“If one side’s troops have to retreat and the other side stays where they are, then what will hold back these other troops, the Russians? Or what will stop them disguising themselves as civilians and taking over this free economic zone? This is all very serious.

“It’s not a fact that Ukraine would agree to it, but if you are talking about a compromise then it has to be a fair compromise.”

Sky News military analyst Michael Clarke gave an ominous assessment of the proposal, saying it left “no physical solution” to resolve the problem of future attacks.

He said: “If Ukraine gives up the fortress cities in the Donbas, the only security they can have is by being heavily armed and being backed by their allies in some way.”

“The only thing that would stop Russia is deterrence: the knowledge that either the European forces were sitting in Ukraine ready to fight for them, which is hard to imagine at the moment, and even harder to imagine that they are backed up by American forces.”

Matthew Savill, director of military sciences at the Royal United Service Institute, was similarly sceptical.

“The general view is that the Russians will be too tempted to… try and come back for more,” he told Sky News.

He added that “some kind of temporary ceasefire” might work, but it would require “the Europeans to demonstrate they can put their forces where their mouth is in terms of a reassurance force”.

Amid this backdrop there was a meeting today of the coalition of the willing – the 34-strong bloc of nations pledged to support Ukraine against Russian aggression, of which Britain is a part.

There was agreement to continue to fund military support, “progress on mobilising frozen Russian sovereign assets”, and an update from Zelenskyy on Russia’s continued bombardment of his country, according to Downing Street.

Afterwards, Zelenskyy said the bloc was working to ensure any peace deal contains “serious components of European deterrence”.

He added: “It is important that the United States is with us and supports these efforts. No one is interested in a third Russian invasion.”

He also addressed growing pressure from the US for an election in Ukraine, saying “there must be a ceasefire” before the country can go to the polls.

👉 Tap to follow Trump100 wherever you get your podcasts👈

Zelenskyy’s term expired last year, but wartime elections are forbidden by law in Ukraine.

Meanwhile, the tone tonight from the White House was one of impatience, with Trump’s team saying he wouldn’t attend further meetings until there’s a real chance of signing a peace deal.

“The president is extremely frustrated with both sides of this war, and he is sick of meetings just for the sake of meeting,” said White House spokeswoman Karoline Leavitt.