North Bay Voice: Local nonprofits vital to community health, resilience

In 2022, California embarked on an ambitious effort to improve health outcomes and reduce health disparities among the 15.3 million people on Medi-Cal, California’s version of Medicaid, the state-federal insurance program for people living on low-incomes.

Called California Advancing Innovations in Medicaid (CalAIM), the program does something remarkable – it acknowledges that factors beyond the doctor’s office and hospital are critical to people’s health – things like housing, food and home asthma prevention like air purifiers. Addressing these “health related social needs” can improve health outcomes while reducing long-term health care costs.

Connecting community members to such services has long been the work of nonprofit organizations (like the Ceres Community Project), which have relied on support from donors and foundations, along with government grants, to provide vital services to community members in need. Community-based nonprofits are embedded in the local health and social care ecosystem and provide experienced and trusted care in ways that best meet the needs of community members. We’re also essential to the safety net – as we saw in the North Bay after the 2017 Tubbs Fire in Sonoma County and during the COVID-19 pandemic.

California’s CalAIM initiative provides a vital opportunity for nonprofits to expand and diversify our funding – and thereby strengthen our overall ability to care for our community – by contracting with Medicaid managed care plans to provide community support such as medically tailored meals or housing navigation services. But two factors are standing in the way – with serious consequences.

The first is that the barriers to contracting with a health care provider are high and expensive, which has limited many nonprofits from jumping in. The second is that for-profit competitors have created an uneven playing field.

This new funding in Medi-Cal is attracting venture-funded for-profit competitors. They offer low rates and ease of contracting across multiple counties for Medicaid managed care plans but often lack a local presence or even direct knowledge of the local community.

Three years into CalAIM, we are seeing the impact of these dual issues. While 54% of contracted providers are nonprofits, the for-profits contract with 30% more managed care plans and in 3.3 times more counties. The result is that an estimated two-thirds of funding – $791 million annually – that could be going to locally based nonprofits is going to for-profit companies. That translates to an average of $13.6 million per county that could be providing vital support to our safety net and local economies – especially at a time when federal funding is at risk.

Ceres Community Project is proud to be supporting an effort to organize community-based nonprofits across the state called the CBO Medi-Cal Coalition, and to be supporting Senate Bill 324. Authored by Sen. Caorline Menjivar, the bill aims to make it easier and more sustainable for nonprofits to contract under MediCal and would require managed care plans to contract with community-based nonprofit providers where experienced and qualified organizations exist.

As a regional nonprofit that has been delivering medically tailored meals to people living with serious illnesses since 2007, we work with and receive referrals from dozens of health care and social care partners. Our client care team comes from and represents the community members we serve. We use 100% organic food and purchase from more than 100 local farms, ranches and dairies.

Our clients frequently report that our smiling volunteer “delivery angels” help them feel cared for and less isolated. And we’re proud to be among the first agencies in the country to earn accreditation from the Food is Medicine Coalition. This is the first standard for agencies delivering the medically tailored meal intervention and verifies that we provide the highest quality of care for the clients we serve.

Ensuring that Medi-Cal dollars go to community-based nonprofit organizations like Ceres Community Project helps to guarantee that patients receive high-quality and culturally relevant care while building the capacity of our community’s economy and safety net.

Cathryn Couch, of Sebastopol, is the Founder and CEO of Ceres Community Project, a regional nonprofit serving Marin, Sonoma, Napa and Solano counties.