Why California is a Hotbed for In-Home Palliative Care

A Medicaid program in California is increasing access to palliative care services in people’s homes.

For about a year, home-based palliative care has been a mandated benefit in California’s Medicaid program, Medi-Cal. Most Medi-Cal beneficiaries are enrolled in managed care plans that contract with agencies that provide these palliative care services, according to a Next Avenue report published Tuesday by Forbes.

“California is truly leading in this regard,” Stacie Sinclair, senior policy manager for the Center to Advance Palliative Care, told Next Avenue, which is a PBS website.


Palliative care provider ResolutionCare, which serves clients in rural northern California, is featured in the article. About 145 of the company’s clients, representing roughly two-thirds of its total customer base, are on Medi-Cal. Many of these people are in their 50s or 60s and are not initially familiar with palliative care, ResolutionCare founder Michael Fratkin told Next Avenue.

California mandates in-home palliative care for people with four conditions: congestive heart failure, chronic obstructive pulmonary disease, end-stage liver disease and late-stage cancers. But ResolutionCare’s services go beyond comfort care and symptom management, given that many of its Medi-Cal customers are facing homelessness, addiction, mental illness, food insecurity and other issues, in addition to serious illness, according to Fratkin. Care varies from brief check-ins for some patients to 30 hours of weekly contact.

Net costs of the palliative care benefit are not yet known, Next Avenue reported, although there is reason to believe that it is saving the health care system money. For instance, a Medicare Advantage plan based in the San Diego area has achieved significant savings related to care for people with dementia and cancer.


If California’s Medicaid model is successful, it could help pave the way for Medicare to offer a palliative care benefit — an outcome that Fratkin would like to see.

In other parts of the country, providers are seeking ways to offer more palliative care without Medicare reimbursement or significant coverage from private insurance. Louisville-based Hosparus Health, for instance, is investing $1 million a year in a palliative care program, aiming to demonstrate the value of this type of care.

Written by Tim Mullaney

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