Whole Person Care (WPC) pilots, under California’s Medicaid Section 1115(a) waiver demonstration, integrate medical, behavioral health, and social needs services to improve the health and wellbeing of high-utilizing Medicaid enrollees. Each pilot focuses on one or more targeted populations, and must engage managed care plans, health service and mental health agencies, and community organizations as partners. This study describes program activities, challenges, and lessons within the first three years of pilot implementation. The results demonstrate how WPC pilots – an example of cross-sector partnerships initiated via Medicaid – can facilitate system-wide changes for individuals with complex needs. Findings may inform other states, counties, and partnerships focused on health system redesign.
WPC pilot sites provided services such as care coordination, housing support, public benefits assistance, outreach and engagement, medical respite, sobering centers, and employment assistance. Pilot sites experienced improvements in developing data-sharing infrastructure among partners, and in identifying and engaging targeted high-need individuals. For example, universal patient data consent forms used by pilot partners led to increased data-sharing capacity of sites over time. Sites had initial challenges in identifying and reaching eligible individuals, but saw positive outcomes from strategies such as deployment of field outreach teams and financial incentives for partners to provide referrals. Housing presented another challenge, as pilot sites could only use WPC funds for housing-related services, but not to cover housing costs such as rent. However, sites leveraged other organizational funding and secured $100 million from the state to cover housing and housing-related costs. WPC funds were leveraged to improve partnerships, infrastructure, and services to better integrate care for Medicaid beneficiaries with complex health and social needs.