Long Term Care Integration Project (LTCIP)


What is LTCIP?

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

Legislative Authority - AB1040

To develop a comprehensive, consumer-centered, integrated continuum of care (health, social and supportive services) that maintains individual dignity, and allows consumers of long term care services to remain an integral part of their family and community life, and pools funding to minimize process and maximize resources.


  • Enhanced consumer participation and self-direction and the right to choice
  • Single and seamless point of entry
  • Expand home and community-based options
  • Assure continuity of care
  • Maintain or enhance consumers' quality of life
  • Provide family caregivers with the full range of affordable and accessible support services, including respite and counseling
  • Provide training and education
  • Meaningful involvement of consumers, providers, advocacy groups and other key stakeholders in the process (planning, monitoring and evaluation)
  • Enhanced flexibility in the use of existing funds to maximize resources and eliminate duplication and fragmentation of services
  • Care provided in the most appropriate, cost effective and least restrictive setting
  • Commitment to quality assurance principles
  • Assure services are culturally and linguistically appropriate
  • Accountability and measurement of outcomes
  • Stakeholder involvement to develop necessary services to meet the needs of consumers
  • Innovative approaches to financial and/or delivery system integration
  • Assure fair compensation for services
  • Provide reliable and easily accessible information and referrals about long term care services
  • Determine necessary information systems and technologies required to decrease service fragmentation and better coordinate care


In 1995, AB 1040 was signed into law to create the Long Term Care Integration Pilot Project to develop demonstration projects to improve the delivery system for long term care services for frail elderly and disabled residents in participating counties. The San Diego County Long Term Care Integration Project (LTCIP) was awarded three planning grants and two development grants from the State Office of Long Term Care (OLTC) to develop a plan for a comprehensive, integrated system of acute and long term care services. Since April 1999, a Planning Committee, comprised of a broad array of over 800 health and social service providers, consumers, caregivers, and advocates, has been engaged in planning activities and receives regular updates on progress and new developments.

To develop a comprehensive, integrated continuum of acute and long-term care (health, social, and supportive services) for the aged, blind, and disabled (ABD) as authorized by AB 1040, designed by local stakeholders, and approved by the Board of Supervisors, that:

  • Provides a single point of entry to care across the health and social service continuum
  • Pools funding to maximize resources and minimize process
  • Is consumer-driven and responsive; expands community-based options for care
  • Expands access to health and social services through a single point of entry
  • Decreases fragmentation, barriers, and duplication
  • Improves quality and cost effectiveness while being "budget-neutral"
  • Is supported by case management and an integrated database
  • Uses existing providers; insures fair compensation across the continuum

After thorough examination of various service delivery models, in January 2001 by consensus decision, LTCIP stakeholders recommended exploring the feasibility of using San Diego County's existing geographic Medi-Cal managed care program, Healthy San Diego (HSD), as the preferred delivery system model to explore. HSD is a geographic Medi-Cal managed care model that incorporates multiple health plans into its design. Unlike other Medi-Cal managed care models, HSD is unique in that County staff within the integrated Health and Human Services Agency support and monitor system-wide issues regarding quality improvement, consumer protection, information management and enrollment activities, in addition to performing eligibility determination. HSD is also unique because it is based on negotiated consensus from community stakeholders and allows for local influence over the program by the advisory body, the Joint Consumer/Professional Advisory Committee. Three representatives of the LTCIP Advisory Group, including the Public Authority Executive Director, were added to the Joint Committee with full voting privileges.

The Board of Supervisors reviewed and approved the recommendation to explore expansion of HSD in March 2002 and also requested development of two additional options, one of those being fee-for-service. Since then, Dr. Mark Meiners, who led the Medicare/Medicaid Integration Program, a multi-state Robert Wood Johnson Foundation initiative with similar goals and a wealth of relevant experience, has helped San Diego develop three smaller, incremental strategies that will help San Diego continue to progress toward the vision of full acute and long-term care integration. These are: (1) HSD+/Health Plan Pilots (2) Physician Strategy (3) Network of Care Strategy. On July 13, 2004, the Board of Supervisors officially approved and supported continued development of all three LTCIP strategies (Minute Order No.17).

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


Click here for the highest-level overview of the three strategies

Health Plan Pilots: Healthy San Diego Plus (HSD+) is one of the three strategies requested by the local Board of Supervisors and supported by key stakeholders in acute and long-term care improvement for elderly and disabled persons in San Diego. HSD+ will be a voluntary, fully integrated service delivery model, with a capitated payment from Medi-Cal, and from Medicare for the "dually eligible." To date, development of the HSD+ model has been supported by the California Department of Health Services Office of Long Term Care (OLTC). The Healthy San Diego Plus model would build on the "medical home" approach provided by the County's Healthy San Diego managed care program for Medi-Cal recipients, extended to include the broader array of services that become possible when Medi-Cal and Medicare are integrated.

The Healthy San Diego Plus model would take full advantage of the ability to improve consumer benefits by pooling Medicare and Medicaid funding, minimizing administrative barriers, eliminating cost shifting incentives, and offering care coordination support to consumers to help them better use community-based social and health care. Healthy San Diego Plus is the most comprehensive of the three LTCIP strategies and, if implemented, would likely be the most effective in creatively meeting the needs of aged and disabled beneficiaries.

Physician Strategy: The underlying goal of this managed fee-for-service delivery model is similar to that of HSD+: quality, consumer-centered health and social services through improved chronic care management, but without the capitation risk. The Planning Phase will target specific stakeholders--physicians, consumers and caregivers, and community-based providers--to help identify strategies and incentives for improving health promotion, care coordination, and chronic care management within the fee-for-service system. A planning grant from the California Endowment was used to support this strategy. Based on the feedback received throughout the course of the work done under the Physician Strategy grant an implementation plan in the form of a new grant application was drafted entitled "Team San Diego." Funding was obtained through the California Endowment and the Alliance Healthcare Foundation to develop "Team San Diego," a community health education strategy that will serve to create "virtual" care teams around individuals with complex needs to improve access to quality, comprehensive and coordinated health programs for vulnerable aged and persons with disabilities. Team San Diego encourages a community infrastructure of support for consumers and their primary care providers around chronic care management.

Network of Care (NoC): The Network of Care, which though not a service delivery option, has the potential to serve as the central data and communication system for the two service delivery models described above. This strategy builds upon an investment made by the County to provide web-based access to a site loaded with local health and social service resources (www.sandiego.networkofcare.org). A three-year Aging and Disability Resource Center (ADRC) Grant from the Administration on Aging and the Centers for Medicare and Medicaid Services that was held in partnership between San Diego's LTCIP, Del Norte Area Agency on Aging, and the California Department of Aging, was used to support this strategy.

The grant helped LTCIP: (1) develop a warehouse of information on self-care management, healthy lifestyle choices, and other information to improve quality of life for our aging and disabled populations; (2) improve the user-friendly nature of information that links health and social services for these user groups; (3) enhance the use of the system as a communication tool, including for the two LTCIP service delivery strategies (HSD+ & Physician Strategy); and (4) perform formalized testing to assess the adequacy of the database and function of this information for physicians, community-based providers, consumers, caregivers and Call Center staff.


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