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Discover Medi-Cal’s Vital Supports for Californians Experiencing or at Risk of Homelessness

California is transforming Medi-Cal to better support and meet the whole-person care needs of members experiencing, or at risk of homelessness. Medi-Cal provides members with access to new and improved services to get well-rounded care that goes beyond the doctor’s office or hospital and addresses their physical and mental health, and also social drivers of one’s health such as housing. Medi-Cal is opening the door to essential health care services for the most vulnerable populations, no matter where they live or seek care.

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Orange, CA - June 3, 2023: Partners in Hope Clothing Distribution, including food and medical help. The event provided showers, washer and dryers, and phone charges for the homeless population.
Orange, CA - June 3, 2023: Partners in Hope Clothing Distribution, including food and medical help. The event provided showers, washer and dryers, and phone charges for the homeless population.

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California is transforming Medi-Cal to better support and meet the whole-person care needs of members experiencing, or at risk of homelessness.

Medi-Cal provides members with access to new and improved services to get well-rounded care that goes beyond the doctor’s office or hospital and addresses their physical and mental health, and also social drivers of one’s health such as housing.

Medi-Cal is opening the door to essential health care services for the most vulnerable populations, no matter where they live or seek care.

Enhanced Care Management
Enhanced Care Management is a new Medi-Cal benefit that assigns a dedicated Lead Care Manager, a personal guide who helps qualified Medi-Cal members navigate all medical, dental, social, and community services such as housing navigation, housing deposits, and more.

Enhanced Care Management takes a whole-person, interdisciplinary approach to care to address clinical and non-clinical needs of members with the most complex medical and social need and serves as a safety net of care coordination for high-risk groups, including, but not limited to, individuals experiencing homelessness.

“Our unhoused population has inadequate access to shelters and experiences a lack of food and care,” said Glenn Tsang, Policy Advisor for Homelessness and Housing for the California Department of Health Care Services. “These members tend to have extensive medical and mental health needs that are difficult to address in an unstable living environment. To help address their needs, the Enhanced Care Management benefit builds consistent connections to medical care, mental health care, substance use disorder treatment, and housing stabilization services.”

Addressing Health-Related Social Needs through Community Supports

Community Supports are services or care settings, in addition to those required under the California Medicaid State Plan, that Medi-Cal managed care plans may elect to offer. The goal of Community Supports is to provide services that address a member’s health-related social needs that may be exacerbating their health condition, such as housing instability. Among the 14 services available as Community Supports services, six are specifically focused on helping unhoused members.

Many of these services empower high-risk individuals and families to live healthier lives in less restrictive settings and avoid unnecessary emergency visits and inpatient nursing facility admissions. They include services that go beyond traditional care received in a doctor’s office and may include housing deposits, housing transition and navigation services, housing tenancy and sustaining services, short-term post-hospitalization, recuperative care, and day habilitation.
Street Medicine
Street medicine is a set of health and social services developed specifically to address the unique needs and circumstances of individuals experiencing unsheltered homelessness, delivered directly to them in their own environment. The fundamental approach of street medicine is to engage people experiencing unsheltered homelessness exactly where they are and on their own terms to maximally reduce or eliminate barriers to care access and follow-through.
Medi-Cal Expansion
Starting on January 1, 2024, all eligible Californians qualify for full scope Medi-Cal coverage, regardless of immigration status.

This expansion allows even more Medi-Cal members to potentially qualify for Enhanced Care Management and Community Supports, among other services, to improve outcomes for California’s most vulnerable populations.

“By expanding Medi-Cal, we’re addressing the root causes of health disparities and providing equitable access to quality health care, leading to a healthy California for all,” said Tsang.

How Providers Support Members
Providers are vital in delivering Medi-Cal’s expanded services, ensuring the most vulnerable members receive the care they need. These providers include, but are not limited to, housing service providers, housing organizations, and other organizations that have an existing footprint consistent with Community Supports activities and in the communities they serve. Providers are essential in providing dedicated care management, ensuring seamless transitions and continuous support across various housing settings.

Street medicine providers also offer direct medical care to individuals on the streets, build trust by consistently providing compassionate services, and use comprehensive care management platforms for efficient coordination. Providers include Federally Qualified Health Centers, mobile medicine units, and many other organizations that provide care to unsheltered members living on the street.

They collaborate with community-based organizations and community support systems like schools, food banks, and housing agencies, and offer proactive support when patients transition through emergency departments, homelessness, or incarceration.

Encouragement to Seek Services
If you or someone you know is experiencing homelessness or is at risk of homelessness, Medi-Cal’s expanded services offer vital support for members enrolled in a managed care plan to improve their health and well-being.

For more information, call the state’s Medi-Cal Managed Care Office of the Ombudsman at (888) 452-8609 or email MMCDOmbudsmanOffice@dhcs.ca.gov.

In Alameda County, Medi-Cal recipients can contact:

*   Alameda Alliance for Health: 510-747-4567

*   Kaiser Permanente: 855-839-7613

In Contra Costa County, Medi-Cal recipients can contact:
*   Contra Costa Health Plan: 877-661-6230

*   Kaiser Permanente: 855-839-7613

In Marin County, Medi-Cal recipients can contact:
*   Partnership Health Plan of California: 800-863-4155

*   Kaiser Permanente: 855-839-7613

In Solano County, Medi-Cal recipients can:
*   Partnership Health Plan of California: 800-863-4155

*   Kaiser Permanente: 855-839-7613

So, if you are at risk of or experiencing homelessness in the Bay Area, your health and well-being matter. Medi-Cal’s expanded services are here to support you every step of the way.

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Oakland Post: Week of November 20 – 26, 2024

The printed Weekly Edition of the Oakland Post: Week of November 20 – 26, 2024

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An Inside Look into How San Francisco Analyzes Homeless Encampments

Dozens of unhoused people are camped at Sixth and Jesse streets in San Francisco’s South of Market neighborhood. Tents made of tarps and blankets, piles of debris, and people lounging alongside the allies and walls of businesses are seen from all angles. These are some of the city’s hotspots. City crews have cleared encampments there over 30 times in the past year, but unhoused people always return.

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Since the ruling of Grants Pass by the US Supreme Court earlier this summer, which allows cities the authority to ban people from camping or sleeping on the streets, San Francisco has been at the head of the conversation to crack down on encampments.
Since the ruling of Grants Pass by the US Supreme Court earlier this summer, which allows cities the authority to ban people from camping or sleeping on the streets, San Francisco has been at the head of the conversation to crack down on encampments.

By Magaly Muñoz

Dozens of unhoused people are camped at Sixth and Jesse streets in San Francisco’s South of Market neighborhood. Tents made of tarps and blankets, piles of debris, and people lounging alongside the allies and walls of businesses are seen from all angles.

These are some of the city’s hotspots. City crews have cleared encampments there over 30 times in the past year, but unhoused people always return.

But it’s normal to have tents set up again within less than 24 hours after an encampment sweep, David Nakanishi, Healthy Streets Operation Center Manager at the Department of Emergency Management, says. Sometimes there’s less people than before but often there is also no change.

“Most of the people that were in the encampments that want to go inside, we’ve gotten the majority of those [into shelter],” Nakanishi says. “Many of the people we encounter now, are those who have various reasons to not accept shelter, and some are already in shelter/housing”.

Since the ruling of Grants Pass by the US Supreme Court earlier this summer, which allows cities the authority to ban people from camping or sleeping on the streets, San Francisco has been at the head of the conversation to crack down on encampments.

Where neighboring cities in the Bay Area are clearing encampments a few days a week, San Francisco is sweeping 10 times a week, two per weekday.

David Nakanishi, Healthy Streets Operation Center Manager at the San Francisco Department of Emergency Management, makes a 311 report on an encampment in the Mission District. These reports allow smaller city teams to tackle individual spots where unhoused people frequent. Photo by Magaly Muñoz.

David Nakanishi, Healthy Streets Operation Center Manager at the San Francisco Department of Emergency Management, makes a 311 report on an encampment in the Mission District. These reports allow smaller city teams to tackle individual spots where unhoused people frequent. Photo by Magaly Muñoz.

Considering the controversy that plagues the city around its harsh policies, the Post decided to tag along on a ride with Nakanishi to show us how he decides what encampments make it on the city’s sweep list.

Nakanishi, having over 20 years of experience in homelessness management, drives around the busiest parts of the city almost daily. He’s tasked with arranging a weekly sweeping operation schedule for city teams to engage with unhoused folks to help get them off the streets.

So what exactly is he looking out for when deciding what encampments get swept?

It depends, he says.

Locations like schools, recreational centers, senior centers, or businesses are places he tends to want to address quickly, especially schools. These are the places where the complaints are highest and access to facilities is important for residents.

He says he also takes into account 311 calls and reports made to him by city staff. On the date of publication, over 100 calls and reports were made about encampments around the city, according to San Francisco data.

Makeshift structures built from plywood and tarps are starting to pop up more throughout the city. Certain areas under freeways are not under direct authority from San Francisco, making it harder to sweep these encampments. Photo by Magaly Muñoz.

Makeshift structures built from plywood and tarps are starting to pop up more throughout the city. Certain areas under freeways are not under direct authority from San Francisco, making it harder to sweep these encampments. Photo by Magaly Muñoz.

Nakanishi made a few 311 reports himself on the ride along, pulling over to take photos and describe the encampments into his 311 app. He says it helps him remember where to possibly sweep next or allows smaller teams in the city to engage quicker with individuals on the streets.

Nakanishi also looks at the state of the encampments. Are there a lot of bulky items, such as furniture, or makeshift structures built out of tarps and plywood, blocking areas of traffic? Is trash beginning to pile up and spill into the streets or sidewalks? Sites that meet this criteria tend to be contenders for encampment sweeps, Nakanishi says.

Street by street, he points out individuals he’s interacted with, describing their conditions, habits, and reasons for denying assistance from the city.

One man on 2nd St and Mission, who rolls around a blue recycling bin and often yells at passing pedestrians, has refused shelter several times, Nakanishi says.

People deny shelter for all kinds of reasons, he says. There’s too many rules to follow, people feel unsafe in congregate or shared shelters, or their behavioral and mental health problems make it hard to get them into proper services.

Inside a tent left by an unhoused man on Stevenson and 14th Street in San Francisco. The area smelled of human waste and leftover alcohol. Photo by Magaly Muñoz.

Inside a tent left by an unhoused man on Stevenson and 14th Street in San Francisco. The area smelled of human waste and leftover alcohol. Photo by Magaly Muñoz.

Nakanishi references another man on South Van Ness under the freeway, who city outreach have attempted to get into shelter, but his screaming outbursts make it difficult to place him without disturbing other people in the same space. Nakanishi says it might be an issue of the man needing resources like medication to alleviate his distress that causes the screaming, but the city behavioral team is in the process of outreaching him to figure that out.

In October, city outreach teams engaged with 495 unhoused people. 377 of those engaged refused shelter and only 118 accepted placements, according to city data. That number of monthly referrals is consistent throughout the entirety of 2024 so far.

Nakanishi has long advocated for the well-being of unhoused people, he explains. In 2004, he was working with the Department of Public Health and told then-Mayor Gavin Newsom that there needed to be more housing for families. Nakinishi was told it was easier to deal with individuals first and the city “will get there eventually.” 20 years later, family housing is still not as extensive as it could be, and the waiting list to get placements for families is a mile long with over 500 names.

In 2020, he was a Senior Behavioral Health Clinician at a hotel in the city during the pandemic. He says in 2021 he collaborated with DPH to provide vaccines to those staying in the makeshift hotel shelters once those became available.

Nakanishi strips apart a solo tent on Stevenson and 14th Street in San Francisco. He discards items, like tarps and cardboard, so that people cannot reuse them to make another sleeping structure. Photo by Magaly Muñoz.

Nakanishi strips apart a solo tent on Stevenson and 14th Street in San Francisco. He discards items, like tarps and cardboard, so that people cannot reuse them to make another sleeping structure. Photo by Magaly Muñoz.

Despite the constant media attention that city outreach is inhumanely treating homeless people, so much so that it has led to lawsuits against San Francisco from advocates, Nakanishi says not a lot of people are seeing the true conditions of some encampments.

He describes soiled clothing and tents, drenched in urine, and oftentimes rodents or bug infestations in places where people are sleeping. He’s asked homeless advocates- often those who are the most critical about the city’s work- who have shown up to observe the sweeps if those are conditions the city should allow people to be subjected to, but not many have answers for him, Nakanishi says.

The city’s “bag and tag” policy allows city workers to throw away items that are “soiled by infectious materials” such as bodily fluids and waste.

Sweep operations are conducted at 8am and 1pm Monday through Friday. People at the encampments are given 72 hour notice to vacate, but some don’t leave the area until the day of the sweep.

City outreach workers come out the day before and day of to offer resources and shelter to those interested. The Department of Public Works discards any trash that is left over from the sweep and washes down the area.

Nakanishi told the Post that the only time the city takes tents or personal possessions from residents is when folks become physically violent towards workers and police take the items as evidence. Other items taken are bagged and tagged in accordance with city policy.

Stories from local newspapers such as the San Francisco Standard and the Chronicle show instances of SFPD handcuffing residents while their items are thrown in the trash or disposing of personal possessions without reason.

Advocates have long been pushing for a more competent and compassionate process if the city is going to choose to continue sweeping unhouse people.

No matter the lawsuits and constant criticisms from allies, the encampment sweeps are not slowing down, even with the cold weather quickly approaching the coastal city.

Nakanishi says there aren’t a lot of large encampments left in San Francisco so now they do runs of streets in order to stretch out the sweeps as much as possible.

It’s calculated strategies and years of first hand knowledge that make this job work, “It takes dedication to the work, caring for the people and the community, and persistence, patience and sometimes good luck to make the positive changes for the people on the street,” Nakanishi says.

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Oakland Post: Week of November 13 – 19, 2024

The printed Weekly Edition of the Oakland Post: Week of November 13 – 19, 2024

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