Statewide Home and Community-
Based Services (HCBS)
Gap Analysis and Multi-Year
Roadmap Stakeholder Meeting
January 20, 2023
California Department of Health Care Services
California Department of Aging
January 2023
This webinar is being recorded.
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2
Introductions and Project
Overview
3
Introductions
» Susan Philip, Deputy Director, Health Care Delivery Systems, Department
of Health Care Services (DHCS)
» Joseph Billingsley, Assistant Deputy Director, Health Care Delivery
Systems, DHCS
» Cortney Maslyn, Chief, Integrated Systems of Care Division (ISCD), DHCS
» Susan DeMarois, Director, California Department of Aging (CDA)
» Sarah Steenhausen, Deputy Director, Policy, Research, and Equity, CDA
» Patricia Rowan (Project Director), Senior Researcher, Mathematica
» Carrie Graham, Director of Long-Term Services and Supports, Center for
Health Care Strategies (CHCS)
4
Purpose of Today’s Webinar
» Introduce the California Department of Health Care Services
(DHCS) and California Department of Aging (CDA) HCBS and
Managed Long-Term Services and Supports (MLTSS) Gap
Analysis projects
» Describe the analytic approach to this work
» Describe opportunities for stakeholder input and feedback
5
Agenda
» Introductions and Project Overview
» DHCS Medi-Cal HCBS/MLTSS Gap Analysis and Multi-Year Roadmap
» Question & Answer
» Break
» CDA Non-Medi-Cal HCBS Gap Analysis and Core Inventory
» Question & Answer
» Opportunities for Stakeholder Input and Feedback
» Public Comment
» Next Steps/Closing
6
Agency/Organization Roles
» DHCS: Oversees the Medi-Cal side of project and provides key data
for Gap Analysis and Multi-Year Roadmap project
» CDA: Oversees the non-Medi-Cal side of project and provides key
data for Gap Analysis and Multi-Year Roadmap project
» Mathematica: Develops the analytic approach, conducts
quantitative and qualitative analyses, and writes the Gap Analysis
and Multi-Year Roadmap documents
» CHCS: Leads stakeholder engagement activities, provides updates to
the project webpage, and monitors email inbox
7
Project Activities
DHCS
• Focus: Medi-Cal Managed LTSS
• Conduct an HCBS Gap Analysis using a
mixed methods approach to identify
critical gaps in California’s Medi-Cal
Managed LTSS (MLTSS) programs and
service delivery system to meet the needs
of Medi-Cal older adults and individuals
with disabilities
• Develop a Multi-Year HCBS Roadmap
• Engage Stakeholders and Experts
CDA
• Focus: Non-Medi-Cal HCBS
• Conduct an HCBS Gap Analysis that
expands on the DHCS HCBS Gap Analysis
to examine gaps and trends in non-Medi-
Cal HCBS
• Develop a Statewide non-Medi-Cal
HCBS Multi-Year Roadmap to advance
statewide HCBS infrastructure
• Create an Inventory of core HCBS
programs and availability by county
• Engage Stakeholders and Experts
8
Intersections Between DHCS and CDA
Projects
» Quantitative analyses for both projects will use data from
various HCBS programs to characterize enrollees and providers
and identify gaps in services
» Approach for both projects will use quantitative and qualitative
data and stakeholder engagement to bring different
perspectives into the gap analyses and roadmaps
» Findings from both projects will be summarized with concrete
plans for filling gaps across HCBS programs
9
DHCS Medi-Cal HCBS/MLTSS Gap
Analysis & Multi-Year Roadmap Details
10
DHCS Gap Analysis and Multi-Year
Roadmap Goals
» Identify and analyze opportunities to expand access to HCBS
» Address and close identified gaps as the state transitions to a
fully-integrated MLTSS system by 2027
» Improve health outcomes, consumer satisfaction, and health
equity for Medicaid beneficiaries in California
11
Money Follows the Person (MFP)
HCBS Capacity Building Award
» MFP* Rebalancing Demonstration
» Supports states’ efforts to rebalance their LTSS systems
» MFP HCBS Capacity Building Initiative
» In 2020, CMS announced a supplemental award opportunity for MFP
grantees "...to accelerate LTSS system transformation, design, and
implementation to expand HCBS capacity"
» CA submitted a proposal to conduct the Gap Analysis and Multi-Year
Roadmap and was awarded $5M in supplemental funding
» Mathematica selected as prime contractor to conduct data analysis
and develop deliverables
» Center for Health Care Strategies (CHCS) is subcontractor to Mathematica to
lead stakeholder engagement
* California's MFP program is known as California Community Transitions (CCT)
12
DHCS Gap Analysis and Multi-Year
Roadmap Previous Stakeholder Engagement
December 4, 2020
» DHCS hosted a webinar to promote collaboration between DHCS and its partners
» Provided an overview of the Capacity Building funding opportunity and DHCS' plan to
commission a Gap Analysis study of the State’s HCBS and MLTSS programs and networks
» Provided an opportunity for public input and feedback
February 17, 2021
» DHCS hosted a webinar to present a detailed outline of the award proposal and receive
additional feedback from stakeholders on the final proposal submitted to CMS
Materials from both webinars available at:
https://www.dhcs.ca.gov/services/ltc/Pages/-MFP-Supplemental-Funding-
Opportunity.aspx
13
DHCS Gap Analysis and Multi-Year
Roadmap Activities
» Gap Analysis
» Use a mixed methods approach to identify critical gaps in California’s
HCBS programs and service delivery system to meet the needs of Medi-
Cal eligible older adults and individuals with disabilities
» Multi-Year Roadmap
» Develop a Multi-Year Roadmap based on the results of the gap analysis
and feedback from DHCS and other stakeholders. The Roadmap will
provide a step-by-step plan to address LTSS needs in the state by:
» Identifying ways to expand HCBS providers’ capacity
» Strengthening partnerships among the state, counties, health plans, providers, and
community-based organizations
» Identifying key milestones and benchmarks to help DHCS monitor progress
14
Gap Analysis and Multi-Year Roadmap
Populations of Focus
Medi-Cal members who may be:
» Receiving HCBS waiver program services
» Receiving Long-Term Care or Skilled Nursing Facility care
» At risk of requiring LTSS, including beneficiaries receiving LTSS or HCBS,
through programs funded under the Older Americans Act (OAA) and
administered locally by Area Agencies on Aging, Aging and Disability Resource
Connections (ADRCs), Independent Living Center (ILCs), or Caregiver Resource
Centers (CRCs)
» Served by CA’s waiver and state plan programs for developmental disabilities
and/or HIV/AIDS
» Certain Medi-Cal Managed Care members
15
Connections to Current Work for CA’s
Long-Term Goals
16
• Master Plan for
Aging
• HCBS Spending Plan
• CA Community
Transitions
• LTSS Data
Dashboard
• Quality
Measures
• Quality Metrics
• Data Reporting
• CalAIM
• No Wrong Door
(NWD)
Managed
Care
Dual Special
Needs Plans
Home and
Community
Based
Services
Managed
Long Term
Services and
Supports
DHCS Gap Analysis and Multi-Year
Roadmap Objectives
» Objective 1: Reducing inequities in access and services
» Objective 2: Meeting client needs
» Objective 3: Program integration and increased coordination
» Objective 4: Quality improvement
» Objective 5: Streamlined access
17
Analytic Questions for Objective 1:
Reducing Inequities in Access and Services
» Who are the current and future users of HCBS in CA? (Where do
they live and what services do they need?)
» Who are the current providers of HCBS in CA? (Where do they
practice and what services do they provide?)
» Which types of HCBS are limited or unavailable in each county?
18
Approach for Objective 1: Reducing
Inequities in Access and Services
» Enrollee assessment
» Identify and describe HCBS users
» Supplement information included in DHCS’ LTSS Data Dashboard
» Examine how the demographic distribution of HCBS users have
changed over time
» Provider assessment
» Identify and describe HCBS providers
» Understand the impact of the pandemic on providers’ availability
» Identify geographic gaps in the number of providers and HCBS
availability
19
Analytic Questions for Objective 2:
Meeting Client Needs
» What are current HCBS use patterns and how have they
changed over time?
» What policy and program changes are needed to expand HCBS
providers’ capacity and improve service quality?
» What standardized metrics can best assess HCBS availability?
20
Approach for Objective 2: Meeting
Client Needs
» Assessment of HCBS use by program and delivery model
» Analyze patterns of HCBS use across counties and over time
» Assess service use relative to the desired core service mix for each
county, as defined in the Master Plan for Aging
» Provide recommendations for mitigating gaps in HCBS
availability
21
Analytic Questions for Objective 3: Program
Integration and Increased Coordination
» How prepared are HCBS providers to fully integrate services
into the managed care system by 2027?
» What resources would support providers, managed care plans,
and CBOs in making this transition?
22
Approach for Objective 3: Program
Integration and Increased Coordination
» MLTSS readiness assessment
» Assess readiness of organizations to provide Enhanced Care Management
(ECM) for specific populations
» Conduct interviews with state groups that represent programs that will join
managed care networks. The goal of interviews is to understand their
readiness to contract with managed care plans and take part in care
management
» Recommendations to promote readiness for fully integrated MLTSS
» Find resources within the state that can help providers
» Talk with consumers about risks to continuity of care during transition to
MLTSS
23
Analytic Questions for Objective 4:
Quality Improvement
» What are the current capabilities and gaps in CA’s approach to
quality measurement and monitoring of HCBS programs?
» What are strengths and weaknesses of current quality
measurement and performance improvement efforts? How can
they be improved?
» What quality improvement resources are available for
providers? What additional resources could be useful for
providers?
24
Approach for Objective 4: Quality
Improvement
» Assess existing HCBS and MLTSS quality data
» Create an inventory of HCBS and MLTSS quality measures used in CA’s
performance measurement and quality improvement initiatives
» Identify measure gaps by each of 11 domains of HCBS quality (as identified by
the National Quality Forum)
» Assess quality improvement resources and training needs
» Create an inventory of current training programs for HCBS providers
» Conduct key informant interviews, focus groups, or surveys of HCBS providers
to learn about the strengths and limitations of these programs
» Recommend measures to prioritize for monitoring a fully integrated
system
25
Analytic Questions for Objective 5:
Streamlined Access
» What are the barriers to accessing HCBS in CA and how can
they be addressed?
» How can DHCS implement a universal baseline assessment to
measure level of need consistently and fairly, and use the
results to direct individuals to appropriate programs?
» What should be the components and which other state
agencies would need to partner with DHCS to implement a “No
Wrong Door” (NWD) system? How much would a NWD system
cost DHCS to implement?
26
Approach for Objective 5: Streamlined
Access
» Assessment of CA’s current No Wrong Door (NWD) system
» Review administrative documentation to develop a thorough understanding of the
current pathways to enrollment
» Conduct key informant interviews with state staff and other potential NWD lead
organizations
» Host listening sessions with various stakeholders (community agencies across the
aging and disability networks, older consumers, younger people with disabilities, and
family members)
» Assessment of feasibility of using a universal assessment tool (UAT)
» Review previous work done by the state’s Legislative Analyst’s Office and the pilot test
of the tool conducted by the DSS
» Review more current assessments by HCBS providers or UATs in use in other states
» Document CA stakeholder’s experiences with UATs and perspectives on UATs during
key informant interviews and listening sessions
27
DHCS Deliverables: Further Details
DELIVERABLE DESCRIPTION DATA SOURCES TIMELINE
HCBS/MLTSS
Program
Inventory
Comprehensive inventory of Medi-Cal
HCBS and MLTSS programs to identify
scope for project analysis
• LTSS Data Dashboard
• Program manuals, CMS
waiver approval letters,
program-specific
webpages/reports
• CA Welfare & Institutions
Code
December 2022
Medi-Cal HCBS
Gap Analysis
Mixed methods approach to identify gaps
in CA’s HCBS programs and services
delivery system to meet the needs of
Medi-Cal older adults and individuals with
disabilities
• Medi-Cal enrollment data,
claims, and encounters
• IHSS claims and assessment
information
• Provider directories
• Key informant interviews,
surveys, and focus groups
with stakeholders
January - August 2023
(Contingent on timing of
data delivery)
28
DHCS Deliverables: Further Details
(con’t)
DELIVERABLE DESCRIPTION DATA SOURCES TIMELINE
Final Gap
Analysis Report
Final report compiling findings from gap
analysis
• Analysis from data listed
above
August 2023 (Contingent
on timing of data delivery)
Multi-Year
Roadmap
Plan to address LTSS needs in the state by
(a) expanding HCBS providers’ capacity;
(b) strengthening partnerships among
stakeholders; (c) identifying benchmarks
to monitor progress.
• Set of recommendations and
timelines based on gap
analysis and feedback from
stakeholders
June 2024 (Contingent on
timing of data delivery)
29
Performance Timeline for Major Activities
Stakeholders updated and engaged throughout project
30
Interrelated DHCS LTSS Initiatives:
California LTSS Dashboard
» DHCS’ goal is to create a public-facing LTSS dashboard to track demographic, utilization, quality,
and cost data related to LTSS. This dashboard links statewide long-term care and HCBS data with
the goal of increased transparency to make it possible for regulators, policymakers, and the public
to be informed while the state continues to expand, enhance and improve the quality of LTSS in all
home, community, and congregate settings
» DHCS released the initial version of California’s Long-Term Services and Supports dashboard in
December 2022
» The LTSS dashboard features data from 2017-2021 and includes 40 measures related to Medi-Cal
enrollment and service utilization
» The LTSS dashboard and the DHCS and CDA Gap Analysis and Roadmap projects are
complementary and part of a larger effort to improve LTSS in the state
» More information is available here: https://www.dhcs.ca.gov/services/Pages/LTSS-Dashboard.aspx
31
Interrelated DHCS LTSS Initiatives:
LTSS Data Transparency
32
»LTSS Data Transparency Initiative will include
» Demographic, utilization, access, quality, and equity measures
to include as part of the state’s LTSS dashboard
» Common set of performance metrics for the state to display
on its LTSS dashboard, that can be leveraged across
programs, providers, and systems of care and is aligned with
the DHCS Comprehensive Quality Strategy
» Recommendations for measures related to demographics,
utilization, equity, and access as informed by the analyses in
Objectives 1 and 2
Interrelated DHCS LTSS Initiatives:
D-SNP Quality Reporting
» State-specific reporting requirements for D-SNPs are part of a larger quality strategy
within DHCS, including a focus on the Comprehensive Quality Strategy focused on dual
eligible individuals, the Long-Term Services and Supports (LTSS) dashboard, and the
Master Plan for Aging.
» DHCS monitors the quality of care and health equity provided to members in Medi-Cal
through various reporting requirements, as detailed in the 2022 DHCS Comprehensive
Quality Strategy and Medi-Cal contracts in the following domains:
» Access/Availability of Care
» Effectiveness of Care
» Utilization and Risk Adjusted Utilization
» Care Coordination
» Organizational Structure and Staffing
» MTLSS
» Alzheimer’s/Dementia Quality of Care
33
Question & Answer
34
Please place questions in the chat and they will be read aloud and
answered by DHCS and Mathematica
Break
35
CDA HCBS Gap Analysis &
Multi-Year Roadmap
36
CDA Project Goals
» Build on DHCS Gap Analysis by developing a similar Gap
Analysis for non-Medi-Cal HCBS in California
» Develop an Inventory of non-Medi-Cal HCBS in California
» Develop a Multi-Year Roadmap to advance non-Medi-Cal HCBS
infrastructure statewide
» Propose measures to monitor progress in advancing statewide
HCBS infrastructure
37
CDA HCBS Gap Analysis Data Sources
and Programs of Focus
» Publicly available non-Medi-Cal HCBS program data, including:
» Nutrition (congregate and home-delivered)
» Caregiver support
» Supportive services
» Independent Living Centers
» Aging and Disability Resource Connections
» Older Americans’ Act programs
» Transportation and mobility services
» Affordable and accessible housing
» Other
38
CDA Project: Deliverables and Timing
DELIVERABLE TIMING* (Approximate)
• Expanded HCBS Gap Analysis
• Inventory of Core HCBS
Programs
• Statewide HCBS Multi-Year
Roadmap
• Winter 2023
• Fall 2024
• Spring 2025
*Timing of deliverables may change based on data availability.
39
CDA Deliverables: Further Details
DELIVERABLE DESCRIPTION DATA SOURCES TIMELINE
Expanded HCBS
Gap Analysis
Report identifying availability of non-Medi-Cal
HCBS in California, identifying gaps in access.
• Publicly available non-
Medi-Cal HCBS program
data, including affordable
and accessible housing
and transportation
Winter 2023
Inventory of non-
Medi-Cal HCBS
Programs
Comprehensive inventory of non-Medi-Cal HCBS
programs and services
• California public data
publishing infrastructure
• Public resources including
Tableau Public
Spring or Summer 2024
Multi-Year non-
Medi-Cal HCBS
Roadmap
Non-Medi-Cal HCBS Multi-Year Roadmap to
promote and support the development of
statewide HCBS infrastructure
• Non-Medi-Cal HCBS Gap
Analysis
• Feedback from
stakeholders
Spring 2025
Measures to
monitor progress
Propose measures to monitor progress, including
equity measures (as available), toward meeting the
milestones of the HCBS Roadmap.
• Driven by stakeholder
feedback and literature; no
data component
Spring 2025 (part of the Roadmap)
40
Question & Answer
41
Please place questions in the chat and they will be read aloud and
answered by DHCS and Mathematica
Opportunities for Stakeholder
Input and Feedback
42
Goals of Stakeholder Engagement
Process
Stakeholder engagement is a key component of both the HCBS
Gap Analysis and the development of the Multi-Year Roadmap
» Analysis of data and the development of the Multi-Year Roadmap
must be clear and transparent
» Timeline of activities and ongoing process must be maintained and
available to the public
» All stakeholder groups must have the opportunity to provide input
at each stage of the project
43
Defining Stakeholders
» Representatives from the following stakeholder groups will be
invited:
» Individuals needing/at risk of needing LTSS
» Organizations/entities that administer and provide LTSS
» Committees, workgroups, or councils that seek to improve quality, equity, and
access in Medi-Cal LTSS
» Internal state agencies, departments, or offices that provide or oversee Medi-
Cal LTSS eligibility, enrollment, services, or related social services or that
collect or analyze data that could be used for LTSS oversight and quality
management purposes
44
Stakeholder Feedback Opportunities
» Two public meetings per year with public comment
» Quarterly updates at existing stakeholder workgroups/advisory groups, such as
CHHS, DHCS/CalAIM, Master Plan for Aging, and Community Living
» Regional in-person and/or virtual listening sessions with consumers and HCBS
caregivers
» Key informant interviews or surveys to solicit targeted feedback on select topics
related to the Gap Analysis or HCBS Roadmap
» Website updates and materials
» Ad hoc input via dedicated email inbox
45
Stakeholder Engagement Timeline
STAKEHOLDER FEEDBACK
OPPORTUNITY
TIMING*
Public meetings Twice per year
Quarterly updates to stakeholder groups
and committees
January 2023-April 2025
Key informant interviews and small group
consultations
Beginning Summer 2023 and
periodically throughout project
Listening sessions with individuals with
lived experience, family caregivers, direct
care workers
Beginning Summer 2023 and
periodically throughout project
* Proposed dates
46
Ways to Participate/Provide Feedback
» CHCS will maintain a list of stakeholders to receive invitations to
public meetings
» Visit the Project Webpage for more information on public events
and to sign up for email updates:
https://www.dhcs.ca.gov/services/ltc/Pages/-MFP-Supplemental-
Funding-Opportunity.aspx
» Have feedback? Please email: HCBSGapAnalysis@dhcs.ca.gov
47
Public Comment
48
Participants are welcome to raise hands to be called on to deliver
your comment/question verbally or place comments/questions in
the Chat
Next Steps/Closing
49
Thank you!
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