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

Published

2 years ago

May 16, 2024

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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

UK

Upcoming budget will be big – and Starmer has some serious convincing to do as he fights for survival

Published

1 hour ago

November 24, 2025

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Upcoming budget will be big - and Starmer has some serious convincing to do as he fights for survival

Wednesday’s budget is going to big.

It will be big in terms of tax rises, big in terms of setting the course of the economy and public services, and big in terms of political jeopardy for this government.

The chancellor has a lot different groups to try to assuage and a lot at stake.

“There are lots of difference audiences to this budget,” says one senior Labour figure. “The markets will be watching, the public on the cost of living, the party on child poverty and business will want to like the direction in which we are travelling – from what I’ve seen so far, it’s a pretty good package.”

The three core principles underpinning the chancellor’s decisions will be to cut NHS waiting lists, cut national debt and cut the cost of living. There will be no return to austerity and no more increases in government borrowing.

Politics Live: Reeves’s ‘mansplaining’ claims are just a ‘smokescreen’, says shadow chancellor

What flows from that is more investment in the NHS, already the big winner in the 2024 Budget, and tax rises to keep funding public services and help plug gaps in the government’s finances.

Some of these gaps are beyond Rachel Reeves’ control, such as the decision by the independent fiscal watchdog (the Office for Budget Responsibility) to downgrade the UK’s productivity forecasts – leaving the chancellor with a £20bn gap in the public finances – or the effect of Donald Trump’s tariffs on the global economy.

Others are self-inflicted, with the chancellor having to find about £7bn to plug her reversals on winter fuel allowance and welfare cuts.

By not pulling the borrowing lever, she hopes to send a message to the markets about stability, and that should help keep down inflation and borrowing costs low, which in turn helps with the cost of living, because inflation and interest rates feed into what we pay for food, for energy, rent and mortgage costs.

That’s what the government is trying to do, but what about the reality when this budget hits?

This is going to be another big Labour budget, where people will be taxed more and the government will spend more.

Only a year ago the chancellor raised a whopping £40bn in taxes and said she wasn’t coming back for more. Now she’s looking to raise more than £30bn.

That the prime minister refused to recommit to his manifesto promise not to raise income tax, VAT or national insurance on working at the G20 in South Africa days ahead of the budget is instructive: this week we could see the government announce manifesto-breaking tax rises that will leave millions paying more.

Freeze to income thresholds expected

The biggest tax lever, raising income tax rates, was going to be pulled but has now been put back in neutral after the official forecasts came in slightly better than expected, and Downing Street thought again about being the first government in 50 years to raise the income tax rate.

On the one hand, this measure would have been a very clean and clear way of raising £20bn of tax. On the other, there was a view from some in government that the PM and his chancellor would never recover from such a clear breach of trust, with a fair few MPs comparing it to the tuition fees U-turn that torpedoed Nick Clegg’s Lib Dems in the 2015 General Election.

Instead, the biggest revenue in the budget will be another two-year freeze on income tax thresholds until 2030.

This is the very thing that Reeves promised she would not do at the last budget in 2024 because “freezing the thresholds will hurt working people” and “take more money out of their payslips”. This week those words will come back to haunt the chancellor.

Two-child cap big headline grabber

There will also be more spending and the biggest headline grabber will be the decision to lift the two-child benefit cap.

This was something the PM refused to commit to in the Labour manifesto, because it was one of the things he said he couldn’t afford to do if he wanted to keep taxes low for working people.

But on Wednesday, the government will announce its spending £3bn-a-year to lift that cap. Labour MPs will like it, polling suggests the public will not.

What we are going to get on Wednesday is another big tax and spend Labour budget on top of the last.

For the Conservatives, it draws clear dividing lines to take Labour on. They will argue that this is the “same old Labour”, taxing more to spend more, and more with no cuts to public spending.

Having retreated on welfare savings in the summer, to then add more to the welfare bill by lifting the two-child cap is a gift for Labour’s opponents and they will hammer the party on the size of the benefits bill, where the cost of support people with long-term health conditions is set to rise from £65bn-a-year to a staggering £100bn by 2029-30.

Mansion tax on the cards

There is also a real risk of blow-up in this budget as the chancellor unveils a raft of revenue measures to find that £30bn.

There could be a mansion tax for those living in more expensive homes, a gambling tax, a tourism tax, a milkshake tax.

Ministers are fearful that one of these more modest revenue-raising measures becomes politically massive and blows up.

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This is what happened to George Osborne in 2012 when he announced plans to put 20% of VAT on hot food sold in bakeries and supermarkets. The plan quickly became an attack on the working man’s lunch from out-of-touch Tories and the “pasty tax” was ditched two months later.

And what about the voters? Big tax and spend budgets are the opposite of what Sir Keir Starmer promised the country when he was seeking election. His administration was not going to be another Labour tax and spend government but instead invest in infrastructure to turbocharge growth to help pay for better services and improve people’s everyday lives.

Seventeen months in, the government doesn’t seem to be doing things differently. A year ago, it embarked on the biggest tax-raising budget in a generation, and this week, it goes back on its word and lifts taxes for working people. It creates a big trust deficit.

Government attempts to tell a better story

There are those in Labour who will read this and point to worse-than-expected government finances, global headwinds and the productivity downgrades as reasons for tax raising.

But it is true too that economists had argued in the run-up to the election that Labour’s position on not cutting spending or raising taxes was unsustainable when you looked at the public finances. Labour took a gamble by saying tax rises were not needed before the election and another one when the chancellor said last year she was not coming back for more.

After a year-and-a-half of governing, the country isn’t feeling better off, the cost of living isn’t easing, the economy isn’t firing, the small boats haven’t been stopped, and the junior doctors are again on strike.

The PM told me at the G7 summit in Canada in June that one of his regrets of his first year wasn’t “we haven’t always told our story as well as we should”.

What you will hear this week is the government trying to better tell that story about what it has achieved to improve people’s lives – be that school breakfast clubs or extending free childcare, increasing the national living wage, giving millions of public sector workers above-inflation pay rises.

You will also hear more about the NHS, as the waiting lists for people in need of non-urgent care within 18 weeks remain stubbornly high. It stood at 7.6m in July 2024 and was at 7.4m at the end of September. The government will talk on Wednesday about how it intends to drive those waits down.

But there is another story from the last 18 months too: Labour said the last budget was a “once in a parliament” tax-raising moment, now it’s coming back for more. Labour said in the election it would protect working people and couldn’t afford to lift the two child-benefit cap, and this week could see both those promises broken.

Can PM convince his MPs?

Labour flip-flopped on winter fuel allowance and on benefit cuts, and is now raising your taxes.

Downing Street has been in a constant state of flux as the PM keeps changing his top team, the deputy prime minister had to resign for underpaying her tax, while the UK’s ambassador to the US, Peter Mandelson, was sacked over his ties to the Jeffrey Epstein, the late convicted paedophile. It doesn’t seem much like politics being done differently.

All of the above is why this budget is big. Because Wednesday is not just about the tax and spend measures, big as they may be. It is also about this government, this prime minister, this chancellor. Starmer said ahead of this budget that he was “optimistic” and “if we get this right, our country has a great future”.

But he has some serious convincing to do. Many of his own MPs and those millions of people who voted Labour in, have lost confidence in their ability to deliver, which is why the drumbeat of leadership change now bangs. Going into Wednesday, it’s difficult to imagine how this second tax-raising budget will lessen that noise around a leader and a Labour government that, at the moment, is fighting to survive.

Environment

Homeowners share surprising, real-world data after installing solar panels

Published

3 hours ago

November 24, 2025

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Homeowners share surprising, real-world data after installing solar panels

Homeowner shares unexpected, real-world data after installing rooftop solar panels: I'm pretty surprised

Are you wondering what kind of results you’d get if you added a home solar system to your roof? Homeowners are sharing their results online — and the real-world data might surprise you!

In a recent post to r/Solar, a Reddit user going by DontBuyBitcoin shared a screenshot indicating that their newly-installed ~11.5 kW system produced over 1,700 kWh of electricity in October. “Pretty surprised by the production of the system I got,” writes DontBuyBitcoin. “11.48KW. I cant wait to see what JUNE-AUGUST [2026] going to look like 😍 I wish SolarEdge will make their app better looking with more functionality”

Home solar energy chart

Other Redditors were quick to share in the enthusiasm. “Congratulations!!! Great numbers,” wrote LegalNet4337. “We got 1.6 MWh with a 14.45 kW system. East and West facing panels in SoCal.”

That 1,700 kWh is nothing to sneeze at. Based on the current national average electricity price of about $0.17/kWh (in AUG2025), DontBuyBitcoin’s admittedly large-ish system translates to ~$290 of potential savings. In a higher rate state like Illinois, with a projected 2026 kWh rate that’s closer to $0.18/kWh, that’s ~$306/mo.

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We expect retail electricity prices to residential customers will average 17 cents per kilowatthour (kWh) nationwide in 2025, a 4% increase over 2024, and then rise to approximately 18 cents/kWh in 2026. This rise continues a trend in which residential electricity prices have increased at an average annual rate of 5% each year since the COVID-19 pandemic. The increase in retail electricity prices this year comes as the cost of natural gas to the electric power sector was up more than 40% in 1H25 compared with a year earlier, with similar year-over-year increases forecast for the remainder of 2025. The average cost of natural gas for power generation in our forecast increases another 17% in 2026.

US ENERGY INFORMATION ADMINISTRATION (EIA)

Those are big numbers, but 11-15 kW rooftop solar systems are big. Significantly bigger, in fact, than the US average, ~6.6 kW in 2024 – but you don’t have to have a big system in order to post big numbers. Superior weather conditions and perfect PV panel placement can also get the job done, as another Redditor found.

“The last 2 days we have had perfect weather here in South Florida and I have been able to get over 30 kWh from a 5 kW system with a 3.8 kW inverter. This is the highest I have seen since getting PTO in September,” wrote Redditor dlewis23, who shared another SolarEdge graph. “I am super happy with seeing over 30 kWh in a single day.”

30 kW/day from home solar

Taken altogether, these real-world snapshots prove that whether it’s a modest 5 kW array or a beefy 10+ kW setup, homeowners out in the real world are seeing meaningful, measurable differences from their home solar installations. And, with retail electricity prices projected to keep on rising through the decade, every kilowatt counts.

Electrek’s Take

When we ran our “Why did you choose to go solar?” survey back in September, only 32.6% of respondents chose, “Lowering my monthly utility bills” as their primary motivation to go solar. That result proved, in my mind, that Electrek readers are just better people than most, and seem to be willing to spend a little more to do something positive for their environment and their community.

That said, wasn’t it no less a thinker than Albert Einstein who said, “Compound interest is the most powerful force in the universe” (Google it.)? And, with a 5% rate hike compounding every year from now until the AI and data center bubbles burst, the impact energy rates may have on all our pocketbooks may be enough to put “Lowering my monthly utility bills” back on top.

If and when that happens: be smart, get several quotes, and understand the difference between buying and leasing your PV system (especially if you plan on selling your home in the foreseeable future).

SOURCES: Reddit, EIA; featured image via Tesla.

If you’re considering going solar, it’s always a good idea to get quotes from a few installers. To make sure you find a trusted, reliable solar installer near you that offers competitive pricing, check out EnergySage, a free service that makes it easy for you to go solar. It has hundreds of pre-vetted solar installers competing for your business, ensuring you get high-quality solutions and save 20-30% compared to going it alone. Plus, it’s free to use, and you won’t get sales calls until you select an installer and share your phone number with them.

Your personalized solar quotes are easy to compare online and you’ll get access to unbiased Energy Advisors to help you every step of the way. Get started here.

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Technology

CNBC Daily Open: Some hope after last week’s U.S. market rout

Published

3 hours ago

November 24, 2025

admin

CNBC Daily Open: Some hope after last week's U.S. market rout

Traders work on the floor of the New York Stock Exchange (NYSE) on Nov. 21, 2025 in New York City.

Spencer Platt | Getty Images

Last week on Wall Street, two forces dragged stocks lower: a set of high-stakes numbers from Nvidia and the U.S. jobs report that landed with more heat than expected. But the leaves that remained after hot tea scalded investors seemed to augur good tidings.

Even though Nvidia’s third-quarter results easily breezed past Wall Street’s estimates, they couldn’t quell worries about lofty valuations and an unsustainable bubble inflating in the artificial intelligence sector. The “Magnificent Seven” cohort — save Alphabet — had a losing week.

The U.S. Bureau of Labor Statistics added to the pressure. September payrolls rose far more than economists expected, prompting investors to pare back their bets of a December interest rate cut. The timing didn’t help matters, as the report had been delayed and hit just as markets were already on edge.

By Friday’s close, the S&P 500 and Dow Jones Industrial Average lost roughly 2% for the week, while the Nasdaq Composite tumbled 2.7%.

Still, a flicker of hope appeared on the horizon.

On Friday, New York Federal Reserve President John Williams said that he sees “room” for the central bank to lower interest rates, describing current policy as “modestly restrictive.” His comments caused traders to increase their bets on a December cut to around 70%, up from 44.4% a week ago, according to the CME FedWatch tool.

And despite a broad sell-off in AI stocks last week, Alphabet shares bucked the trend. Investors seemed impressed by its new AI model, Gemini 3, and hopeful that its development of custom chips could rival Nvidia’s in the long run.

Meanwhile, Eli Lilly’s ascent into the $1 trillion valuation club served as a reminder that market leadership doesn’t belong to tech alone. In a market defined by narrow concentration, any sign of broadening strength is a welcome change.

Diversification, even within AI’s sprawling ecosystem, might be exactly what this market needs now.

What you need to know today

And finally…

The Beijing music venue DDC was one of the latest to have to cancel a performance by a Japanese artist on Nov. 20, 2025, in the wake of escalating bilateral tensions.

Screenshot

Japanese concerts in China are getting abruptly canceled as tensions simmer

China’s escalating dispute with Japan reinforces Beijing’s growing economic influence — and penchant for abrupt actions that can create uncertainty for businesses.

Hours before Japanese jazz quintet The Blend was due to perform in Beijing on Thursday, a plainclothesman walked into the DDC music club during a sound check. Then, “the owner of the live house came to me and said: ‘The police has told me tonight is canceled,'” said Christian Petersen-Clausen, a music agent.

— Evelyn Cheng

Correction: This report has been updated to correct the spelling of Eli Lilly.