Like many states, California uses managed care delivery systems to administer Medi-Cal, the state’s Medicaid program. Currently, more than 80 percent of Medi-Cal enrollees are in managed care plans, a number that will increase as California Advancing and Innovating Medi-Cal (CalAIM) seeks to implement broad delivery system, program, and payment reforms.

One CalAIM reform initiative, the “institutional long-term care carve-in,” will require that care in nursing homes and other institutional settings be provided as a benefit through Medi-Cal managed care plans statewide as of January 2023.

This report describes challenges, opportunities, and lessons from select California counties and other states where institutional long-term care has already been administered by Medicaid managed care plans. The report focuses on the experiences of seniors and adults with disabilities, including those with Medi-Cal only and those with both Medi-Cal and Medicare (dually eligible enrollees), and describes opportunities to improve access, quality, equity, and care experience across long-term care settings.