Analysis of 2019 Cal MediConnect Rapid Cycle Polling Project Findings

2019 Findings from

the Cal MediConnect

Rapid Cycle Polling Project

Conducted for

The SCAN Foundation

In conjunction with

The California Department

of Health Care Services

By

Institute for Health and Aging,

University of California, San Francisco 

May 2019

Previous reports looked at overall frequencies and compared those in Cal

MediConnect (CMC), to those who opted out and those in non-demonstration

counties.

The prime objective of these analyses was to compare CMC enrollees’

experiences by county, race, language, and disability using the following

characteristics:



The seven participating counties: 

San Bernardino, San Diego, Santa Clara,

San Mateo, Orange, Los Angeles, and Riverside



Race: 

White, Black, Asian/Pacific Islander, and Hispanic/Latino



Language of survey administration: 

English, Chinese, and Spanish



Need for Long-Term Services and Supports (LTSS): 

No LTSS need, those with

routine needs only, and those with need for personal care assistance



Background: In 2014, California implemented a dual financial alignment

demonstration called the Coordinated Care Initiative. As part of this

demonstration new integrated health plans, called Cal MediConnect (CMC),

were created in seven counties for people eligible for both Medicare and

Medi-Cal.



Dually eligible beneficiaries enrolled in CMC had all of their medical care,

ancillary services, and long-term services and supports (LTSS) coordinated

through one integrated managed care plan.



CMC enrollees received some new benefits such as care coordination and

non-emergency transportation.



While specialty behavioral health was carved out, mild to moderate

behavioral health benefits were provided through CMC, and CMC care

coordinators were tasked with coordinating with specialty behavioral health

county providers.

Survey Method



Telephone interviews with stratified random samples of dual eligible

beneficiaries in Cal MediConnect (CMC) counties

Populations Surveyed



2015: CMC enrollees in five counties (Los Angeles, Riverside, San Bernardino,

San Diego, and Santa Clara)



2016 through 2018: CMC added two counties (San Mateo and Orange)

Sample Sizes of CMC Enrollees by Survey Year



2015: 2,764 CMC enrollees



2016: 3,351 CMC enrollees



2017: 1,779 CMC enrollees



2018: 1,775 CMC enrollees

Aggregate Sample Size of CMC Enrollees (across all years)



9,669 CMC enrollees

About the Surveys

Sample of CMC Enrollees by County and Year

CMC Enrollees by County

Sample of CMC Enrollees by Race and Language of Survey Administration and

Year

*Note: Race sample size=8907. Respondents who answered “other” or “not recorded” were excluded from the analysis.

CMC Enrollees by Race and Language

Sample of CMC Enrollees by Type of LTSS Needs and Year

CMC Enrollees by Need for Long-Term Services and Supports

* This item about LTSS needs distinguished between no LTSS needs, personal care needs,

and routine care needs and was only asked in 2017 and 2018.

** Routine needs were defined as needing help with everyday household chores, doing

necessary business, shopping or getting around for other purposes. This category only

includes those who need only routine care, and does not include those who need both

routine and personal care.

*** Personal care needs were defined as needing help with eating, bathing, dressing, or

getting around inside the home. Most people who needed personal care also needed

routine care.

Summary

Findings in Brief

Confidence navigating health care was fairly high for all CMC enrollees, and

seemed to increase between 2015 to 2018. While there were no significant

differences in 2018 by county, there were some significant differences by race,

language, and disability.

By race, Asian/Pacific Islanders (API) expressed less confidence than White or

Black groups in their confidence managing their health conditions, knowing who

to call, and getting their questions answered.

By language, English-speaking CMC enrollees were significantly more likely to be

“very confident” on all measures compared to Spanish speakers and Chinese-

speaking enrollees.

By disability, those CMC enrollees who had no LTSS needs expressed higher

confidence that they could manage their health conditions and that they could

get their questions answered compared to CMC enrollees with only routine

needs, or those with personal care needs.

CMC Enrollees’ Confidence Navigating Health Care

There were some significant differences across counties in satisfaction with

choice of doctors and choice of hospitals by race, language, and disability.

By race, there were significant differences across all satisfaction questions. In

particular, Latinos were least likely to say they were “very satisfied” with their

choice of doctors and hospitals. Both Latinos and API were least likely to be

very satisfied with their ability to call a health provider regardless of the time

of day.

By language, English-speaking CMC enrollees were most likely to be satisfied

with almost all aspects of their health care compared to Spanish- and Chinese-

speaking enrollees.

By disability, CMC enrollees with personal care needs were the most satisfied

with the hospitals they could use. Those with no LTSS needs were most

satisfied with how long they had to wait to see a doctor when they needed an

appointment.

CMC Enrollees’ Satisfaction with Health Care Services

There were few differences by county in problems encountered with health care,

with the exception of a question only asked of non-English-speaking enrollees

about access to interpreters. Those in Santa Clara and San Mateo Counties were

the most likely to say they were not provided an interpreter when they needed

one.

By race, White enrollees were most likely to report misunderstandings about

coverage, denied treatment, or that a doctor was not available. In contrast, API

enrollees were most likely to report problems accessing interpreters,

transportation problems, and trouble communicating with providers.

Language was similar to race in that English-speaking enrollees were most likely

to report misunderstandings about coverage, denied treatment, or that a doctor

was not available. Chinese–speaking enrollees were most likely to report

problems accessing interpreters and transportation problems.

CMC enrollees with personal care needs were more likely than those with

routine needs or no needs to report problems in all six areas queried.

CMC Enrollees’ Problems Encountered with Health Care

By 2018, CMC enrollees in San Mateo County were the most likely to say they had

a personal doctor. They were also the most likely to say that their personal doctor

was the same doctor they had before they transitioned to CMC.

By race, API CMC enrollees were the most likely to report having a personal

doctor and also the most likely to say their doctor was the same that they had

before CMC. White CMC enrollees were the most likely to say they had been

seeing their personal doctor for a year or less.

Similarly, by language, 100% of Chinese-speaking CMC enrollees said they had a

personal doctor and they were the most likely to have been seeing the same

doctor since before CMC.

By disability, CMC enrollees with personal care needs were the most likely to say

they had a personal doctor and slightly more likely than those with no LTSS needs

or routine needs to say they had the same doctor since before CMC.

CMC Enrollees’ Experiences with a Personal Doctor*

* 

A “personal doctor” was defined in the survey as “the doctor who knows you best and can refer you to other doctors

when you need to see a specialist.”

There were few differences by county in those who reported having a single care

manager,* with the exception that CMC enrollees in San Mateo County who did

have a single care manager were the most likely to say their single care manager

was from the plan.

By race, API were the most likely to report having a single care manager, but the

least likely to report having a personal care plan.** Latino and Black CMC

enrollees who had a single care manager were most likely to say that the single

care manager improved their care “a lot.”

By language, English-speaking CMC enrollees were the most likely to report they

had a single care manager and personal care plan. Chinese speakers who had a

single care manager were the least likely to say it had improved their care “a

lot.”

By disability, those with personal care needs were significantly more likely to

have a single care manager and personal care plan compared to those with no

LTSS needs or only routine needs.

CMC Enrollees’ Use of Single Care Managers

and Personal Care Plans

* A single care manager was defined in the survey as a nurse or other helper from their health plan who serves as

their main point of contact and can arrange all aspects of their care.

** A personal care plan was defined in the survey as a plan designed to take into account their health goals, needs

and preferences.

There were significant differences by county in the percentage of CMC enrollees

getting assistance with care needs, getting In-Home Supportive Services (IHSS),

their monthly IHSS hours, and unmet needs for personal care*.

By race, API CMC enrollees were the most likely to say that they need assistance

with personal care and reported the highest unmet needs.  API and Black CMC

enrollees were more likely than White and Latino enrollees to report using IHSS.

By language, Chinese-speaking CMC enrollees were the most likely to report

having needs for assistance with personal care, using IHSS, and the most likely to

report unmet needs for personal care.

By disability, those with personal care needs were most likely to get assistance

with personal care, most likely to get IHSS, and had the highest average monthly

hours compared to those with fewer needs. They were also the most likely to

have unmet needs.

CMC Enrollees’ Long-Term Services and Supports

Needs and Use of In-Home Supportive Services

* Personal care needs defined as: eating, bathing, dressing, or getting around inside the home.

** Routine needs defined as: everyday household chores, doing necessary business, shopping or getting around for other

purposes

Results by CMC Counties

CMC enrollees across all counties expressed high levels of confidence in

navigating their health care.

In 2015, just under half of enrollees in all counties said they were very

confident they knew how to manage their health conditions. By 2017, over

half of CMC enrollees in most counties said they were very confident, with no

significant differences by county.

A majority of enrollees also said they “know who to call” if they have a health

need or a question about their health. The only year there was a significant

difference across counties was in 2017, when San Mateo County had the

highest percentage of endorsement at 93% and Los Angeles County had the

lowest endorsement at 85%. By 2018, there were no longer significant

differences by county.

CMC Enrollee Confidence Getting Questions

Answered by County - 2018

P-VALUE: 0.043

In 2018, for the first time there were differences by county in CMC enrollees

who said they had a personal doctor. 100% of San Mateo County enrollees said

they had a personal doctor, while 89% of San Diego County CMC enrollees said

they had a personal doctor.

In 2016 (the first year that San Mateo County was included), 76% of CMC

enrollees in San Mateo County said that they still had the same personal doctor

they had before enrolling in CMC. By 2018, San Mateo County was still the

highest at 70%, with Orange County the lowest at 59%.

 Personal Doctor by County

Personal Care Doctor by 

County - 

2016 and 2018

In 2018, 91% of San Mateo County CMC enrollees said they were very or

somewhat satisfied with their choice of doctors (the highest of all the counties).

In 2018, over 90% of San Mateo County and San Bernardino County CMC

enrollees said they were very or somewhat satisfied with their choice of

hospitals (the highest of all the counties).

Choice of Providers by County

Choice of Doctor by County

P-VALUE: 0.012

Choice of Hospital by County

P-VALUE: 0.019

Relatively small proportions of CMC enrollees said they encountered any of six

specific problems relating to their health services in the recent past.

The only specific problem that was significantly different by county was among

non-English-speaking enrollees who were asked if their doctor did not speak

their language and an interpreter was not provided. The highest percentages

were reported by CMC enrollees in Santa Clara County (36%) and San Mateo

County (30%). The lowest percentages were reported in Riverside and San

Bernardino Counties (8% and 6%, respectively).

Specific Problems with Health Care Services by County

Specific Problems with Health Care Services – 2018 (1)

Had a misunderstanding

about your health care

services or coverage

Was denied a treatment

or referral for another

service recommended by

a doctor

Specific Problems with Health Care Services – 2018 (2)

Transportation problems

kept you from getting

needed health care

A doctor you were seeing is

not available through your

plan

Specific Problems with Health Care Services – 2018 (3)

Had trouble communicating

with a health provider

because of a speech, hearing

or other disability

Doctor did not speak your

language and there was not

an interpreter available by

county*

* P-VALUE: <0.001

There were no significant differences by county in the percent of CMC enrollees

who reported having a single care manager or personal care plan.

Of those who did have a single care manager in 2018, 88% of San Mateo County

CMC enrollees said their single care manager was from the plan (highest %),

compared to 56% of Orange County CMC enrollees (lowest %).

Thirty-five percent of Santa Clara County CMC enrollees who did not have a

single care manager said that having one would improve their care “a lot.”

Single Care Manager and Personal Care Plan by County

Single Care Manager by County

P-VALUE: 0.001

Single Care Manager from the CMC Plan

P-VALUE: 0.011

In 2018, there were NO differences in health/disability characteristics by

county in the following measures:

•

Self-rated health

•

Hospital admissions

•

Use of mental health services

•

Use of medical equipment and supplies

•

Deaf or serious difficulty hearing

•

Blind or serious difficulty seeing while wearing glasses

•

Difficulty walking or climbing stairs

•

Difficulty dressing or bathing

•

Doing errands alone or visiting a doctor’s office or shopping

Health and Disability Related Characteristics of

CMC Enrollees by County

In 2018 there were differences by county in:

•

Getting services or assistance with bathing, dressing, help preparing meals,

help doing housework, or grocery shopping. San Bernardino County at 29%

and Orange County at 19% were the lowest.

•

Those with a disability using In-Home Supportive Services (IHSS). Orange and

San Diego Counties were the lowest at 15% and 20%, respectively; Los

Angeles, Santa Clara and San Mateo Counties were the highest at 34%.

•

Average number of monthly IHSS hours among users differs significantly by

county.  Orange County was the lowest at 72 hours, while San Mateo and

Santa Clara Counties were the highest at over 100 hours.

•

There was no significant difference by county in unmet needs reported for

personal or routine care. Between 32% and 46% in all the counties reported

they ”could use more help with personal care needs.”

Getting Services or Assistance with Personal Care

and Routine Care by County

Getting Services or Assistance with

Routine or Personal Care - 2018

Personal care needs P-VALUE: 0.020; Routine care needs P-VALUE: 0.016

Getting All the Help Needed for

Personal Care Needs by County - 2018

P-VALUE: <0.001

IHSS Use Among People with LTSS Needs –

2017 and 2018

Asked only of enrollees who report using LTSS,

2017 & 2018 P-VALUE: <0.001

IHSS Use Among People with LTSS Needs

A

sked only of enrollees who report using IHSS

Results by Race

In 2018, similar to previous years, White and Black CMC enrollees were

significantly more likely than Latinos or Asian/Pacific Islander (API)  enrollees to

say:

•

Very or somewhat confident they know how to manage their health

conditions (91% of White and Black enrollees, compared to 77% of Latinos

and 75% of API enrollees).

Asian/Pacific Islanders were also least likely to say:

•

They know who to call if they have a question about their health (82%,

compared to 88% of Latinos, 94% of White and Black enrollees).

•

They know how to get their questions answered (51%, compared to 64% of

White and 66% Black enrollees).

Enrollees’ Confidence Navigating Health Care by Race

Enrollees’ Confidence Navigating Health Care

by Race - 2018

Know how to manage

your health

conditions (% very or

somewhat confident)

Know who to call if

you have a health

need or question (%

yes)

Can get questions

about your health

needs answered (%

very or somewhat

confident)

API CMC enrollees were most likely to have a personal doctor (98%).

API CMC enrollees were also the most likely to have the same doctor they had

before enrolling in CMC (75%, compared to 66% Black enrollees, 60% Latinos,

and 53% of White CMC enrollees).

White CMC enrollees were the most likely to have been seeing their personal

doctor less than a year (21%).

Personal Doctor by Race

Has a 

Personal Doctor by Race - 2018

P-VALUE: 0.002

There were significant differences by race for all questions related to

satisfaction with care in 2018.

Latinos were least likely to say they were “very satisfied” with their choice of

doctors and hospitals in 2018 (only 25% were very satisfied).

Both Latinos and API were the least likely to be very satisfied with their ability

to call a health provider regardless of the time of day.

Satisfaction with Health Care Services by Race

Satisfaction with Health Care Services by Race

P-VALUE: <0.001

Choice of 

Doctors 

– 2018

Satisfaction with Health Care Services by Race

P-VALUE: <0.001

Choice of Hospitals – 2018

Satisfaction with Health Care Services by Race

P-VALUE: <0.001

Information Given Explaining Benefits – 2018

Satisfaction with Health Care Services by Race

P-VALUE: <0.001

Ability to Call Health Plan Regardless of Time of Day – 2018

Satisfaction with Health Care Services by Race

P-VALUE: <0.001

Time Your Doctor and Other Staff Spend With You– 2018

Satisfaction with Health Care Services by Race

P-VALUE: <0.001

Wait Time To See Your Doctor When You Need an

Appointment – 2018

Satisfaction with Health Care Services by Race

P-VALUE: <0.001

The Way Different Health Care Providers Work Together to

Give You the Services You Need – 2018

API CMC enrollees were most likely to report they had a single care manager

from the CMC plan (75% compared to 63% of Black enrollees).

Latino and Black CMC enrollees who had a single care manager were most likely

to say that the single care manager improved their care “a lot” (68% of Latinos

and 65% of Black CMC enrollees, compared to only half of White or API

enrollees).

API CMC enrollees were least likely to have a personal care plan (only 18% of

API, compared to about a quarter of White and Latinos, and 38% of Black

enrollees).

Enrollees’ Experiences with Single Care Manager and

Personal Care Plan by Race

Enrollees’ Experiences with Single Care Manager

and Personal Care Plan by Race

P-VALUE:

0.001

Single care manager

from the CMC plan

Personal care plan

White CMC enrollees were most likely to report the following problems in

2018:

•

Misunderstanding about your health care services or coverage (20%)

•

Health plan denied a treatment or referral recommended by a doctor (19%)

•

A doctor you were seeing was not available through your plan (20%)

API CMC enrollees were most likely to report the following problems in 2018:

•

Your doctor did not speak your language or there was not an interpreter

available when you visited your doctor or other health care professional

(40% of API enrollees compared to 9% of Hispanic/Latino enrollees)*

•

Transportation problems kept you from getting needed health care (20%)

•

Had trouble communicating with a doctor or health care provider because of

a speech, hearing or other disability (23%)

Specific Problems with Health Care Services by Race

* Only asked of respondents who took the survey in a language other than English.

API CMC enrollees were the most likely to say that they need assistance with

personal care (68% compared to 43% of White enrollees).

Black CMC enrollees were most likely to say they need assistance with routine

needs such as chores, shopping, and getting around (82%).

API CMC enrollees were the mostly likely to say they had unmet needs for

personal or routine care. Forty-six percent of API, 38% of Latinos, 37% of White,

and 36% of Black CMC enrollees had unmet need for long-term services and

supports (LTSS).

API and Black CMC enrollees were the most likely to report using In-Home

Supportive Services (IHSS) (43% and 42%, respectively). White (23%) and

Latinos (24%) were the least likely to report using the service for personal care.

     Long-Term Services and Supports

Use and Need of CMC Enrollees by Race

P-VALUE: 0.001

Do you usually get all

the help you need

with personal care

and/or routine needs?

(% needing more help)

Currently using IHSS

P-VALUE: 0.004

Comparing the Health Characteristics by Race

In 2018, Black CMC enrollees were the most likely to say they were in fair or

poor health (65%, compared to 56% of API, 47% of Latinos, and 43% of White

CMC enrollees).

API CMC enrollees were the least likely to report hospitalization in the last year

(14%, compared to about a quarter of other races).

Comparing the Demographic Characteristics of

CMC Enrollees by Race

API CMC enrollees are much more likely to be 75 years old or older (71%),

compared to only 33% of White enrollees, and 34% of Black enrollees.

Black and White CMC enrollees are much more likely to live alone (44% and

38%, respectively), compared to only 8% of API and 17% of Latino/Hispanic

CMC enrollees.

Results by Language

It is no surprise that there were major differences by language in CMC

enrollees’ confidence managing health care in all years.

In 2018, 64% of English-speaking CMC enrollees said they were very confident

they knew how to manage their health conditions, compared to only 20% of

Chinese-speaking and 48% of Spanish-speaking enrollees.

In 2018, 92% of English speakers said they knew who to call if they had a health

need or questions about their health, compared to 87% of Spanish speakers

and 77% of Chinese speakers.

Finally, while 66% of English speakers said they were very confident they could

get their questions answered, only 43% of Spanish speakers and 36% of Chinese

speakers had the same confidence.

Enrollees’ Confidence Navigating Health Care

by Language

Enrollees’ Confidence Navigating Health Care

by Language

Know how to manage

your health conditions

(% very or somewhat

confident)

Know who to call if you

have a health need or

question (% yes)

Can get questions about

your health needs

answered (% very or

somewhat confident)

CMC Enrollees’ Confidence Getting Questions

Answered by Language - 2018

P-VALUE: <0.001

CMC Enrollees’ Confidence Getting Questions

Answered by Language - 2018

P-VALUE: <0.001

Know who to call if you have a health need or question (% yes)

CMC Enrollees’ Confidence Getting Questions

Answered by Language - 2018

P-VALUE: <0.001

Confidence Getting Questions Answered

In 2018, 100% of Chinese-speaking CMC enrollees said they had a personal

doctor. This was an increase from 92% in 2015.

In 2018, 92% of English-speaking CMC enrollees and 94% of Spanish-speaking

enrollees said they had a personal doctor.

In 2018, 75% of Chinese speakers reported they had the same doctor as before

enrolling in the program, compared to only 63% of English speakers and 57% of

Spanish speakers.

Personal Doctor by Language

Personal Doctor by Language

Having a personal doctor

Having the same doctor

as before enrolling in CMC

English speakers were the most likely to be “very satisfied” with the following

aspects of their health care*:

•

Choice of hospitals (38%, compared to about 20% of Spanish and Chinese

speakers)

•

Information the health plan has given you explaining your benefits (36%,

compared to 25% of Spanish speakers and 21% of Chinese speakers)

•

Ability to call a health care provider regardless of the time of day (33%,

compared to 16% of Spanish speakers and 13% of Chinese speakers)

•

The amount of time your doctor and other staff people spend with you (43%,

compared to 25% of Spanish speakers and 28% of Chinese speakers)

•

How long you have to wait to see a doctor when you needed an appointment

(34%, compared to 18% of Spanish speakers and 20% of Chinese speakers)

•

The way different health care providers work together to give you the services

you need (36%, compared to 19% Spanish speakers and 22% Chinese speakers)

* Most of these differences are no longer significant if you collapse “very satisfied” with “satisfied”

Satisfaction with Health Care Services by Language

Orange

Choice of Doctor - 2018

Satisfaction with Different Aspects of the Health Care

Services by Language

Satisfaction with Different Aspects of the Health Care

Services by Language

Choice of Hospital - 2018

Information Given Explaining Benefits – 2018

Satisfaction with Different Aspects of the Health Care

Services by Language

Satisfaction with Different Aspects of the Health Care

Services by Language

Ability to Call Health Plan Regardless of Time of Day – 2018

Time Your Doctor and Other Staff Spend With You – 2018

Satisfaction with Different Aspects of the Health Care

Services by Language

Wait Time To See Your Doctor When You Need an Appointment – 2018

Satisfaction with Different Aspects of the Health Care

Services by Language

Satisfaction with Different Aspects of the Health Care

Services by Language

The Way Different Health Care Providers Work Together to Give You the

Services You Need – 2018

Single Care Manager and Personal Care Plan

by Language



English speakers were the most likely to have a single care manager (32%,

compared to 16% of Spanish and Chinese speakers).



Chinese-speaking CMC enrollees who had a single care manager were the

least likely to say their single care manager has improved their care “a lot”

(only 30%, compared to 60% of English speakers and 62% of Spanish

speakers).



English-speaking CMC enrollees were the most likely to say they had a

personal care plan (30%, compared to 23% of Spanish speakers and 12% of

Chinese speakers).

Single Care Manager and Personal Care Plan

by Language

Having a single care manager

Having a personal care plan

English-speaking CMC enrollees were the most likely to report the following

problems in 2018:

•

Had a misunderstanding about health care services or coverage (18%,

compared to less than 10% of Spanish and Chinese speakers)

•

Health plan denied treatment or referral for another service recommended

by a doctor (18%, compared to less than 10% of Spanish and Chinese

speakers)

•

A doctor you were seeing was not available through the plan (18%,

compared to 16% of Spanish speakers and 3% of Chinese speakers)

Chinese-speaking CMC enrollees were the most likely to report the following

problems:

•

Doctor did not speak your language or there was not an interpreter available

(38%, compared to 8% of Spanish speakers)

•

Transportation problems kept you from getting needed health care (26,%

compared to 13% of English speakers and 8% of Spanish speakers)

Specific Problems with Health Care Services

by Language

Specific Problems with Health Care Services

by Language

Transportation problems kept you from getting needed health care

Spanish speakers were most likely to report their health was fair or poor (48%,

compared to 41% of English speakers and 37% of Chinese speakers).

English-speaking CMC enrollees were most likely to report using specialized

equipment such as a cane, wheelchair, scooter, or special bed, etc. (48%,

compared to 40% of Spanish speakers and 30% of Chinese speakers).

English-speaking CMC enrollees were most likely to report they had been in the

hospital overnight in the last 12 months (23%, compared to 20% of Spanish-

speakers and 9% of Chinese speakers).

English-speaking CMC enrollees were most likely to report using mental health

care (19%, compared to less than 10% of the other groups).

Health-Related Characteristics of CMC Enrollees

by Language

Global Self-Rating of Health

Health-Related Characteristics of CMC Enrollees

by Language

Disability and Long-Term Services and Supports

Use of CMC Enrollees by Language

Chinese-speaking CMC enrollees were most likely to report needing assistance

with personal care (76%, compared to 54% of English-speaking enrollees and

43% of Spanish-speaking enrollees).

Chinese-speaking enrollees were the most likely to be using In-Home

Supportive Services (IHSS) (60%), compared to about a quarter of English- and

Spanish-speaking CMC enrollees.

There were no significant differences by language in need for assistance with

routine activities like chores, shopping, or getting around for other purposes.

Spanish-speaking CMC enrollees were the least likely to report unmet needs for

personal and routine care (33%, compared to 42% for English speakers and 44%

for Chinese speakers).

Disability and LTSS Use of CMC Enrollees by Language

Personal care needs

Routine care needs

In 2018, English-speaking CMC enrollees were the most evenly split by gender,

with 46% male and 54% female. Spanish- and Chinese-speaking enrollees were

60% female.

Chinese-speaking CMC enrollees were by far the oldest, with 87% aged 75 or

older, compared to 36% of English-speaking enrollees and 49% of Spanish-

speaking enrollees.

Thirty-three percent of English-speaking CMC enrollees lived alone. This was

significantly higher than Spanish-speaking (13%) or Chinese-speaking (6%)

enrollees.

Other Demographics by Language

Results by Need for

Long-Term Services and

Supports

Respondents were put into three different categories based on their self-

reported need for long-term services and supports (LTSS), including: 1) No need

for LTSS; 2) Needs assistance with routine tasks; and 3) Needs assistance with

personal care (bathing, dressing, eating).

In 2018, CMC enrollees with no LTSS needs were more likely to feel “very

confident” that they know how to manage their health conditions (61%,

compared to 51% of CMC enrollees with routine care needs and 44% of those

with personal care needs).

Fifty-six percent of CMC enrollees with no LTSS needs or just routine needs

(57%) were slightly more likely to feel “very confident” they could get their

questions answered, compared to those with personal care needs (54%).

CMC Enrollee Confidence Navigating Health Care

by Long-Term Services and Supports Need

CMC Enrollee Confidence Navigating Health Care

by LTSS Need

Confidence Managing Conditions

In 2018, 95% of CMC enrollees with personal care needs said they had a

personal doctor. This is slightly higher than those with no LTSS need (93%) and

those with only routine needs (94%).

Sixty-four percent of CMC enrollees with personal care needs said that their

personal doctor was the same doctor they had before enrolling in CMC. This is

slightly higher than those with no LTSS needs (63%) and much higher than

those with only routine needs (55%).

Personal Doctor by LTSS Needs

Having a personal doctor

Having the same doctor

as before enrolling in CMC

Personal Doctor by LTSS Needs

Eighty-two percent of CMC enrollees with personal care needs were satisfied

with the hospitals they could use. This is slightly higher than the 79% of those

with no LTSS needs or only routine needs who were similarly satisfied.

Eighty-two percent of CMC enrollees with no LTSS needs were satisfied with

their wait time to see a doctor when they needed an appointment. This is

higher than the 75% of those with routine needs, and 77% of those with

personal care needs.

Satisfaction with Health Care Services by LTSS Need

Choice of Hospital -2018

Satisfaction with Health Care Services by LTSS Need

CMC enrollees with personal care needs were most likely to have a single care

manager (34%) compared to those with no LTSS needs (21%) and those with

only routine needs (28%).

CMC enrollees with personal care needs were also most likely to have a

personal care plan (32%) compared to those with no LTSS need (24%) and those

with only routine needs (29%).

Single Care Manager and Personal Care Plan

by LTSS Need

Having a single care

manager

Having a personal

care plan

Single Care Manager and Personal Care Plan

by LTSS Need

CMC enrollees with personal care needs were more likely than those with no

LTSS needs and those with only routine needs to experience all six of the

following problems with their health care services:

•

Having a misunderstanding about their health care services

•

Health plan denied treatment or referral for another service recommended

by a doctor

•

[For non-English interviews] Your doctor did not speak your language or

there was not an interpreter available for you when you visited your doctor

or other health care professional

•

Transportation problems kept you from getting needed health care

•

A doctor you were seeing was not available through your plan

•

You had trouble communicating with a doctor or health car provider

because of a speech, hearing, or other disability

Specific Problems with Health Care Services

by LTSS Need

Specific Problems with Health Care Services

by LTSS Need

Note: *p<0.05, **p<0.01, ***p<0.001

More CMC enrollees with personal care needs reported their health as

fair/poor (65%) compared to those with no LTSS needs (34%) and those with

routine needs only (60%).

More CMC enrollees with personal care needs had been hospitalized overnight

in the last 12 months (33%), compared to those with no LTSS needs (14%) and

those with only routine needs (27%).

Health-Related Characteristics of CMC Enrollees

by LTSS Need

Overall

Los

Angeles

Riverside

San

Bernardino

San

Diego

Santa

Clara

San

Mateo

Orange

Health reported as

“fair/poor”

Was hospitalized in the

last 12 months

Health-Related Characteristics of CMC Enrollees

by LTSS Need

Seventy-seven percent of CMC enrollees with personal care needs reported

using specialized equipment such as a cane, wheelchair, scooter, special bed, or

other assistive device, compared to 28% of those with no LTSS need and 57% of

those with routine needs only.

Seventy-seven percent of CMC enrollees with personal care needs were getting

assistance with LTSS, compared to 10% of those with no LTSS needs and 47% of

those with routine needs only.

Forty-four percent of CMC enrollees with personal care needs had unmet needs

for LTSS, compared to 33% of those with routine needs only.

Of those with routine needs only, 41% were getting In-Home Supportive

Services (IHSS). Of those with personal care needs (average of 75 hours per

month), 70% were getting IHSS (average of 100 hours per month).

LTSS Use and Unmet Need of CMC Enrollees

by LTSS Need

Getting assistance

(

bathing, dressing, preparing

 meals, housework, or grocery

 shopping

)

Do you usually get all the

help you need?

(

I could use more help

)

LTSS Use and Unmet Need of CMC Enrollees

by LTSS Need - 2018

CMC Enrollees by LTSS Need - 2018

Appendix

Education

•

Overall, San Bernardino County had the highest percentage of CMC enrollees

who were high school graduates (26%) and San Mateo County had the

highest percentage of college graduates (17%).

•

Overall, Hispanic/Latino CMC enrollees had the highest percentage of

individuals having some high school or less (69%). Asian/Pacific Islanders

had the second highest percentage of enrollees with some high school or

less (34%). The percentage of Asian/Pacific Islanders with a college degree

was also the highest (25%).

•

The number of enrollees having LTSS needs who graduated college increased

from 2015 (7.3%) to 2018 (10%)

Age

•

Santa Clara and San Mateo Counties had the largest percentage of CMC

enrollees over the age of 75, and this older population has grown since

2015.

Age (cont’d)

•

Santa Clara County had 42% of their enrollees 75 years old or older in 2015,

and by 2018 this percentage grew to 56%.

•

San Mateo County had 48% of their enrollees 75 years old or older in 2016,

and by 2018 this percentage grew to 65%.

•

Los Angeles County also experienced a similar growth from 2015 (33%) to

2018 (50%) in its oldest CMC enrollees.

•

Asian/Pacific Islanders have the largest percentage of enrollees who are

older than 75 years of age (2015: 57%, 2018: 70%).

•

Older individuals with LTSS needs have also increased over the surveyed

years (2015: 40%, 2018: 54%).

CMC Enrollees’ Other Characteristics (2)

Gender

•

There are a greater number of female CMC enrollees compared to males

across all characteristics and years.

•

The difference in percentage of females compared to male enrollees is most

apparent for Hispanic/Latino, Black, and Asian/Pacific Islander enrollees.

•

Across all years, more females than males have LTSS needs.

Household Composition

•

San Diego County has the largest percentage of enrollees who live alone

(2018: 34%).

•

Across all years, White non-Hispanic (2018: 38%) and Black (2018: 44%)

enrollees have the largest percentage of individuals living alone, compared

to Hispanic/Latino (2018: 17%) and Asian/Pacific Islander (2018: 8%)

enrollees.

•

IBM SPSS Statistics for Macintosh, Version 21.0 was used for statistical

analyses such as frequencies and chi-squared tests to compare differences

across comparison groups within survey year.

•

IBM SPSS Statistics for Windows, Version 23.0 was used to weight the data to

adjust the polling sample so that it was representative of the target

population. Weights were derived using a form of post-stratification

weighting known as Raking or RIM weighting. RIM weighting permits the

adjustment of multiple characteristics in a dataset all at the same time in a

way that it keeps the different characteristics proportionate as a whole. The

following population estimates were obtained from DHCS in 2017 and used

with the SPSS Raking procedure – gender (male, female); language (ASL,

Spanish, Cantonese, Mandarin, English, other sign languages); age; and

county. Weights were determined separately for the three groups: CMC

enrollees, dually eligible beneficiaries who chose to opt-out of the CMC

program, and dually eligible beneficiaries in non-participating CMC counties.

Carrie Graham, PhD, MGS, Principal Investigator

Leslie Ross, PhD, Research Specialist

Irene Liu, Research Assistant

University of California, San Francisco

Institute for Health and Aging

For questions or comments, please contact:

Carrie Graham, PhD, MGS

clgraham@berkeley.edu