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Community Living Fund report: referrals rise but data and engagement gaps slow enrollments
Summary
Program Analyst Zhiqing Lee told the DOS Commission that the Community Living Fund received 306 new referrals Jan–Jun 2024 and now serves 308 unique clients, but staff cited fragmented data systems and many cold referrals from the San Francisco Health Plan that limited enrollment and reporting.
Zhiqing Lee, a program analyst in the Department of Disability and Aging Services’ Office of Community Partnerships, told the DOS Commission that the Community Living Fund (CLF) received 306 new referrals during January–June 2024 and provided services to 308 unique clients during the period. "Eighty‑five percent of these referrals were made by SFHP for ECM services," Lee said, and added that many referred members were not informed a referral had been made on their behalf, resulting in low engagement by phone outreach.
The CLF uses a two‑pronged model of coordinated case management and purchases of services to prevent unnecessary institutionalization. Lee said the program delivered coordinated case management to 226 clients (about 73% of the CLF caseload), including 136 through Enhanced Care Management (ECM) and 90 through traditional intensive case management (ICM). Ninety‑two clients — nearly 30% of the caseload — received housing subsidies through the ScatterSite Housing and Rental Subsidy program managed by Brilliant Corners.
Lee highlighted operational challenges. The CLF currently records data across two systems — PACE Care Online (PCO) and KACE care — and staff reported difficulty producing consistent performance measures while migrating records to PCO. "During the recent reporting period, the main challenge faced was the difficulty in reporting performance measures due to the data being distributed across different systems," Lee said. The program also noted a higher share of referrals with unknown race or ethnicity (about 20%), a pattern staff attributed to referral records coming from SFHP that lacked demographic fields.
On cost and revenue, Lee reported a net increase in CLF expenses of $353,828 compared with the prior period and an average monthly program cost per client of $2,378. Staff said some of the increase was due to filling previously vacant positions (the CLF has recently hired a program supervisor and four case managers) and somewhat higher operating expenditures. Billing and claims for CalAIM ECM services began to arrive in late June with an initial payment of $10,250; DAS staff later stated the program has received over $275,000 to date from CalAIM but said projections remain preliminary as systems and billing processes stabilize.
Commissioners pressed on outreach and equity. Commissioners asked whether the new outreach coordinator was increasing warm referrals to under‑represented communities (API and LGBTQ+ were specifically called out) and whether referrals from Laguna Honda Hospital would rise as admissions resumed after that facility’s recertification. Lee said the CLF had hired a new outreach coordinator, was expanding relationship‑building with skilled nursing facilities beyond Laguna Honda, and planned more community education and outreach.
Staff described next steps as strengthening data migration to PCO, continuing outreach to increase warm referrals from SFHP and other partners, and monitoring revenue realization from CalAIM to determine how much state funding will offset city expenditures. The commission did not take action; this was an informational item.
