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

Published

1 year 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

Entertainment

Noel Clarke ordered to pay at least £3m of Guardian publisher’s legal fees

Published

23 mins ago

September 23, 2025

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Noel Clarke ordered to pay at least £3m of Guardian publisher's legal fees

Noel Clarke has been ordered to pay at least £3m of The Guardian publisher’s legal costs after losing his “far-fetched” libel case over allegations of sexual misconduct reported by the newspaper.

The first article, published in April 2021, said some 20 women who knew the actor and filmmaker in a professional capacity had come forward with allegations including harassment and sexually inappropriate behaviour.

Clarke, best known for his 2006 film Kidulthood and for starring in Doctor Who, sued Guardian News and Media (GNM) over seven articles in total, as well as a podcast, and vehemently denied “any sexual misconduct or wrongdoing”.

Following a trial earlier this year, a High Court judge found the newspaper’s reporting was substantially true, agreeing with the publisher’s defence of its reporting as both true and in the public interest.

At a hearing to determine costs on Tuesday, Clarke represented himself – saying in written submissions to the court that his legal team had resigned as he was unable to provide funding for the hearing.

Mrs Justice Steyn ruled that he must pay £3m ahead of a detailed assessment into the total costs to be recovered, which lawyers for the publisher estimated to be more than £6m.

“The claimant maintained a far-fetched and indeed a false case that the articles were not substantially true, by pursuing allegations of dishonesty and bad faith against almost all of the defendant’s truth witnesses,” the judge said.

The sum of £3m sought by GNM was “appropriate and no more than what ought to be reasonably ordered in this case”, she added, and “substantially lower than the defendant’s likely level of recovery”.

Clarke, 49, told the court he used ChatGPT to prepare his response to GNM’s barrister Gavin Millar KC, who asked the judge to order £3m as an interim payment – which he said was “significantly less” than the “norm” of asking for 75%-80%.

The actor described the proposed costs order as “excessive”, “inflated” and “caused by their own choices”, and asked the court to “consider both the law and the human reality of these proceedings”.

He also requested for the order on costs be held, pending an appeal.

“I have not been vexatious and I have not tried to play games with the court,” Clarke said. “I have lost my work, my savings, my legal team, my ability to support my family and much of my health.

“My wife and children live every day under the shadow of uncertainty. We remortgaged our home just to survive.

“Any costs or interim payments must be proportionate to my means as a single household, not the unlimited resources of a major media conglomerate.

“A crushing order would not just punish me, it would punish my children and wife, and they do not deserve that.”

Detailing GNM’s spend, Mr Millar said about 40,000 documents, including audio recordings and transcripts, had to be reviewed as a result of Clarke bringing the case against then. He highlighted a number of “misconceived applications” made by the actor which “required much work from the defendant’s lawyers in response”.

During the trial, the actor accused GNM – as well as a number of women who made accusations against him – of being part of a conspiracy aiming to destroy his career.

This conspiracy allegation “massively increased the scale and costs of the litigation by giving rise to a whole new unpleaded line of attack against witnesses and third parties,” Mr Millar said in written submissions to the court.

Clarke originally asked for damages of £10m, increasing to £40m and then £70m as the case progressed, the barrister said.

He must now pay GNM the £3m within 28 days, Mrs Justice Steyn ruled.

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World

‘Islamic NATO’ in the making – why Saudi-Pakistan defence deal could be game changing

Published

23 mins ago

September 23, 2025

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'Islamic NATO' in the making - why Saudi-Pakistan defence deal could be game changing

While Britain and America were engrossed in the pageantry and diplomacy of a US presidential visit last week, another event pretty much went unnoticed in most Western capitals – and it could have a profound impact on geopolitics.

The “Strategic Mutual Defence Agreement” was signed by Saudi Crown Prince Mohammed bin Salman and Pakistan Prime Minister Shehbaz Sharif on 17 September.

Seen as an “Islamic NATO” in the making, at its core is the clause that “any aggression against either country, shall be considered an aggression against both”.

Article 5 of NATO states the same, and is the cornerstone principle of collective defence that binds members of the alliance.

If an ally is attacked, each member will consider it an attack against them all and will take action to help. This clause has often been cited since Putin’s war on Ukraine.

Pakistan and Saudi Arabia have a longstanding relationship, with Pakistan willing to defend the holy sites of Mecca and Medina as Shia Iran threatened the Kingdom.

The new pact between Sunni Saudi Arabia, a country considered the heart of the Islamic world, with Pakistan – the only Muslim nuclear nation – is bound to set a new order.

Pakistani defence minister Khawaja Asif said “the deterrence that we get from nuclear weapons, and what we have, and the capabilities we possess, will be made available to Saudi Arabia according to this agreement”.

Pakistan has also not ruled out other Islamic nations joining the coalition and its deputy prime minister, Ishaq Dar, said “other countries have also expressed a desire for similar arrangements”.

The signing took place a week after Israel launched airstrikes against Hamas officials discussing US ceasefire proposals in a Qatari government complex.

The unprecedented attack in Doha has shattered the illusion of American reliability in the region for rich Arab and Gulf countries.

Israel’s menacing military strikes – in Iran, Lebanon, Yemen, Syria and Qatar – have precipitated the idea of a protective nuclear umbrella of their own.

Major blow for India

A cash-strapped, politically unstable and quasi-military Pakistan, willing to share its weapons, is a win-win for both countries.

It’s a coup for Pakistan because a client like Saudi Arabia puts it centre stage in the Islamic world, with its credibility sky high and the potential for more patrons.

It has also dealt a major diplomatic and security blow to nuclear arch rival India, against whom it’s fought multiple wars and clashes.

Relations between Saudi Arabia, Gulf nations and India have improved considerably over the years.

But the concern is, would the pact automatically bring these nations into Pakistan’s corner if there was a conflict with India.

After the deadly clashes between the two countries in May, India’s Prime Minister Narendra Modi said “we have merely suspended our retaliatory actions against Pakistan’s terrorist and military targets for now”.

India’s foreign ministry said it would “study the implications for national security and regional and global stability”.

It added: “India and Saudi Arabia have a wide-ranging strategic partnership which has deepened considerably in the last few years. We expect that this strategic partnership will keep in mind mutual interests and sensitivities.”

However, there will be worry and concern in the Indian establishment as its nemesis has prized open a door which they hope does not become a chasm.

The Indians will be hoping the pact remains one of just political solidarity and doesn’t transform into unconditional war guarantees.

India’s diplomacy faces huge challenges; it has been singled out by President Trump for a punitive 25% extra tariff for buying discounted Russian oil, taking the total to 50%, one of the highest in the world.

Relations with China have also been very difficult over the years, while ties between Pakistan and China have strengthened into an all-weather friendship.

The Saudi-Pakistan deal aims to expand military cooperation, joint exercises and intelligence sharing to counter threats, terrorism and cross-border insurgencies.

It also covers the transfer of technology and co-production of military equipment between the countries.

This pact could change the course of the Middle East as Pakistan’s 170 warheads provide the Kingdom with a deterrent that might later expand to cover other countries – an Islamic NATO with potential to reshape the world.

World

Thousands flee homes as Super Typhoon Ragasa approaches Hong Kong

Published

23 mins ago

September 23, 2025

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Thousands flee homes as Super Typhoon Ragasa approaches Hong Kong

Flights have been cancelled, schools and businesses have closed, and thousands of people have been forced to leave their homes as one of the strongest typhoons of recent years approaches southern China and Hong Kong.

Super Typhoon Ragasa, with winds near its centre of around 137mph (220kmh), according to Hong Kong’s observatory, is travelling across the South China Sea towards Guangdong province, the southern Chinese economic powerhouse.

At least three people have died and more than 17,500 displaced by flooding and landslides in the Philippines because of the storm, categorised as a “super typhoon” by the observatory because it contains winds of more than 115mph (185kmh).

Ragasa is expected to make landfall in the coastal area between the cities of Zhuhai and Zhanjiang in Guangdong on Wednesday between midday and evening, local time, China’s National Meteorological Centre said.

Sandbags and barriers have been placed by doors to protect homes, and windows and glass doors have been taped ahead of expected high winds.

Many people stockpiled food and other supplies on Monday, and some market traders said their goods were selling out fast.

Hurricane-force winds were forecast across a wide area, the observatory said, confirming it will issue the third-highest storm warning signal in its weather alert system, on Tuesday afternoon.

Winds of 84mph (135kph) were recorded near the ground at a distance of about 75 miles (120km) from the typhoon’s centre, it said.

Water levels may go as high as four to five metres (13ft to 16ft) above the typical lowest sea level, while coastal areas could see rises of up to two metres (6.5ft).

Schools were closed in Hong Kong and the neighbouring city of Macao, while classes were cancelled in other cities, including the tech hub of Shenzhen.

Hundreds of flights were cancelled in Hong Kong. Shenzhen Airport will halt all flights from Tuesday night.

The Macao government was evacuating residents and tourists and ordered bridges to close in the evening as it expected Ragasa would pass within 62 miles (100km) to the south of the casino hub on Wednesday morning.

At least six people were injured and over 7,000 people were evacuated in Taiwan when the typhoon swept south of the island, and over 8,000 households lost power, the Central News Agency reported.

As well as the three known to have died, five others are missing in the Philippines because of Ragasa, the most powerful storm to hit the Southeast Asian archipelago this year, the country’s disaster-response agency and provincial officials said.