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 details the experiences of the Health Plan of San Mateo (HPSM), a participant in California’s Cal MediConnect financial alignment demonstration, as it implements a pilot program to help dually eligible individuals in nursing facilities transition back to community living and those at risk of nursing home placement to remain in the community.
Lessons from this pilot may help other health plans, states, and providers develop approaches to serving dually eligible individuals with extensive LTSS needs. HPSM is a participant in Promoting Integrated Care for Dual Eligibles (PRIDE), a national initiative made possible by The Commonwealth Fund.