UCLA CHPR evaluated Whole Person Care, a statewide "Medi-Cal 2020" Section 1115 Medicaid Waiver program.

The California Department of Health Care Services (DHCS) implemented a Section 1115 Medicaid Waiver called “Medi-Cal 2020,” which started on January 1, 2016, and ended on December 31, 2021. Under this Waiver, DHCS implemented Whole Person Care (WPC) for high-risk, high-utilizing enrollees who had a complex profile, with multiple service needs.

A total of 25 Pilots, representing the majority of counties in California, implemented WPC starting in January 2017. WPC required participating Pilots to identify and enroll eligible Medi-Cal beneficiaries; coordinate care across health, behavioral health, and social services; involve relevant stakeholders; and share data in real-time with the goals of improved care delivery, better health, and lower costs.

Whole Person Care at a Glance

The WPC final evaluation report shows that WPC Pilots:

  • Invested in promoting meaningful and diverse partner engagement and buy-in through consistent communication, consensus on strategic priorities, and/or financial incentives.
  • Acquired and implemented innovative data sharing platforms needed to support cross-sector care coordination and facilitate data sharing with partners.
  • Were successful in developing appropriate infrastructure (e.g., staffing, standardized protocols) and processes (e.g., needs assessment, care plan, referrals) to support effective care coordination.

In addition, the final evaluation report shows that WPC enrollees:

  • Use of outpatient services increased in the first year of WPC. Comparing trends from before to during WPC, enrollees had a reduction in primary care, an increase in specialty care, a decline in mental health care, and an increase in substance use treatment for enrollees overall vs. the control group.
  • Had an overall reduction in ED visits and hospitalizations and an increase in long-term stays relative to the control group
  • Had a reduction in overall estimated Medi-Cal costs compared to controls. The examination of costs for relevant categories of service showed that the decline in overall costs was likely accomplished through a decline in hospitalizations, outpatient services, and emergency department visits.

All Pilots or partners have transitioned to providing Enhanced Care Management (ECM) and/or Community Supports (CS) under the California Advancing and Innovating Medi-Cal (CalAIM) program. The findings of this evaluation highlight care coordination best practices and the potential for similar programs to make impacts that result in better care, better health and lower costs for high-risk Medicaid beneficiaries.

The data provide a roadmap for the creation of similar programs intended support low-income patients with high levels of unmet needs for nontraditional health services, such as care coordination. Many of the strategies used by Whole Person Care pilots were innovative and have succeeded in engaging those enrolled in their care and addressing their needs.