Long Term Care Integration Project (LTCIP)

For more information phone 858-495-5853 or send us an email.



The next Long Term Care Integration Project (LTCIP) Quarterly Stakeholder meeting will be held on Friday, December 9, 2016 from 8:30am to 10:00am at Aging & Independence Services located in the County Operations Center at 5560 Overland Ave., 3rd floor San Diego, 92123 in the JA Training Conference Room. 

For more information about the LTCIP please contact the Manager of the LTCIP, Kristen Smith, at (858)495-5853 or at Kristen.Smith@sdcounty.ca.gov

LTCIP Updates

Coordinated Care Initiative (CCI)

In July 2012, legislation was passed in California that established the Coordinated Care Initiative (CCI) to transform the State’s Medi-Cal (Medicaid) care delivery system.  CCI integrates the administration of medical, behavioral, and long-term services and supports for older adults and persons with disabilities into a single organized delivery system.

San Diego was selected as one of seven California counties to implement CCI. Implementation began in San Diego County in April 2014.

What is the Coordinated Care Initiative (CCI)?

  • Mandatory enrollment of dual eligible beneficiaries into Medi-Cal managed care health plans
  • Integration of Medi-Cal long-term services and supports (LTSS) into Medi-Cal managed care
    • All Medi-Cal beneficiaries (64,000), including approximately 57,000 Dual Eligible beneficiaries in San Diego County, will be required to join one of five Medi-Cal managed care health plans: Care1st, Community Health Group, Health Net, Molina or Kaiser to receive their Medi-Cal benefits, including LTSS and Medicare wrap-around benefits.
  • Dual Eligible (Medicare/Medi-Cal beneficiaries) Demonstration called Cal MediConnect
    • Includes behavioral health coordination

For more information about CCI and recent updates please click the CCI/Cal MediConnect link to the right under related links heading. 

The Community-Based Care Transitions Program (CCTP)

The San Diego Care Transitions Partnership (SDCTP), a partnership between Aging & Independence Services (AIS) and Palomar Health, Scripps Health, Sharp HealthCare and the University of California San Diego (UCSD) Health System (13 hospitals) was awarded the Community-based Care Transitions Program (CCTP) by the Centers for Medicare and Medicaid (CMS) to improve care transitions for high-risk, fee-for-services (FFS) Medicare patients. The SDCTP program has provided a unique opportunity to learn what is required to scale up a comprehensive care transitions program to serve a large, diverse population of high risk patients; test new care transition interventions; improve the health of the community in a predominantly managed care county; and to innovate with clinical and social service partners who endorse a shared vision to transform care for FFS Medicare patients across the continuum. 

Between January 2013 and August 2016, more than 51,000 FFS Medicare beneficiaries received comprehensive services to reduce their risk for a readmission.  The SDCTP's success has resulted in several program extensions.  During the final extension period from July 1, 2016 - January 31, 2017 AIS will work with Palomar Health, Scripps Health, and Sharp HealthCare.  The SDCTP continues to work collaboratively to identify ways in which person-centered, coordinated, acute and post-acute care transitions services may continue to be delivered to high-risk FFS Medicare patients as well as to other high-risk patient populations across the county after CCTP concludes.

Home & Community-Based Services (HCBS) Brokerage Guide

Changes in the healthcare environment, initiated through such programs as the Coordinated Care Initiative (CCI) in California and the Community-based Care Transitions Program (CCTP), have highlighted the need for community-based supportive services to help medically complex individuals to live as independently as possible in their own homes and communities. However, healthcare organizations often find it challenging to keep abreast of the wide array of community-based support expertise and services that these individuals typically require. 

To address this issue, Aging & Independence Services (AIS), in partnership with Collaborative Consulting and a team of diverse healthcare and home and community-based services (HCBS) thought leaders, authored a Home & Community-Based Services (HCBS) Brokerage Guide that provides a road map for establishing a brokerage for HCBS.  The implementation of a HCBS brokerage would enable easy access to a network of quality HCBS that support individuals to receive the right services, at the right time, and in the setting of their choice.

The project was supported by a grant from The SCAN Foundation - advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, visit www.TheSCANFoundation.org.

Want to learn more about the Long Term Care Integration Project?

For more information about LTCIP please contact Kristen Smith, Manager of the LTCIP, at (858)495-5853 or Kristen.Smith@sdcounty.ca.gov.