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Centene’s Health Net is rolling back an assisted living transition service for Medi-Cal members, a health plan spokesperson confirmed to Becker’s on Aug. 18, marking the end of this Health Net assisted living transition benefit after several years of operation.
What the Health Net Assisted Living Transition Benefit Actually Provided
Through the California Advancing and Innovating Medi-Cal initiative, a multiyear transformation plan for the state’s Medicaid program, Community Supports are optional services to address health-related social needs. Some focus on transitional rent for members at risk of homelessness or personal care. The Assisted Living Facility Transition Community Support specifically aims to bring members at home or in a nursing facility to an assisted living facility, keeping them in a community and preventing institutionalization.
Why Health Net Was an Early Adopter
Health Net said it was an “early adopter” of the optional Community Supports but will discontinue this specific service Jan. 1, ending its participation in one of the earlier and more targeted optional benefits under the state’s CalAIM framework.
Why Health Net Is Ending This Assisted Living Transition Benefit
“Based on several years of experience and data, our data shows that the Assisted Living Facility Transition Community Support has not led to better care or fulfilled the state’s goal of being a cost-effective alternative to services covered under Medi-Cal, as measured by fewer ER visits and days in the hospital when compared to a control group of similar members who did not use the optional service,” the spokesperson said in a statement.
What This Data-Driven Rationale Suggests
By explicitly citing comparative data against a control group of similar members, Health Net is framing this decision as evidence-based cost-effectiveness analysis rather than a broader retreat from optional Community Supports services generally, distinguishing this specific benefit cut from a wholesale rollback of CalAIM participation.
How Health Net Is Managing This Assisted Living Transition Wind-Down
Health Net said it is working with members, care management teams, providers and the state to establish personalized transition plans, as well as determine eligibility for other programs. Eligible members can still receive the service through their current authorization period, giving currently enrolled patients a defined runway before the change takes full effect.
The Scale of Members Affected
The insurer did not respond to a question about how many people would be affected, but CalMatters reported Aug. 17 that approximately 3,500 Medi-Cal patients use to cover assisted living costs. CalViva Health and Community Health Plan of Imperial Valley also contract with Health Net, meaning the practical reach of this benefit cut could extend beyond its own direct membership.
What This Health Net Assisted Living Transition Decision Means Going Forward
With the Jan. 1 discontinuation date now confirmed and Health Net citing years of comparative outcomes data as its rationale, the roughly 3,500 affected Medi-Cal patients and their care teams will need to navigate the transition to alternative programs before their current authorization periods expire. Given that this decision stems from a specific cost-effectiveness finding rather than a broader CalAIM policy shift, other California Medicaid managed care plans offering similar assisted living transition benefits may face pressure to produce their own outcomes data justifying continued investment in the service.
What to Watch Going Forward
As the Jan. 1 effective date approaches, industry observers will likely watch how many of the roughly 3,500 affected members successfully transition to alternative programs versus facing gaps in support, and whether other Medi-Cal managed care plans reach similar conclusions about this specific Community Support’s cost-effectiveness. Given it’s framing of this decision around data showing no reduction in ER visits or hospital days compared to a control group, this Health Net assisted living transition discontinuation may prompt broader scrutiny of which optional CalAIM Community Supports services are delivering their intended cost and care outcomes across California’s Medicaid managed care landscape.
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