Many individuals with long-term services and supports (LTSS) needs either reside in institutions or are at risk for institutionalization. Rebalancing care to provide LTSS in the community is one goal of the federal Financial Alignment Initiative for Medicare-Medicaid enrollees.
This profile, developed with support from The Commonwealth Fund, describes an innovative pilot program developed by the Health Plan of San Mateo, a participant in California’s Cal MediConnect financial alignment demonstration. The pilot is designed to help dually eligible individuals in nursing facilities transition back to community living and support those at risk of nursing home placement to remain in the community. Lessons may help other health plans, states, and providers develop approaches to better serve dually eligible individuals with extensive LTSS needs.