A Path to Successful Closed Loop Referrals in Medi-Cal

By Health Team

January 18, 2024

Top image via iStock from ozgurdonmaz

Being a parent is a daily juggling act – from school/daycare pickups and drop offs, to work commutes and cleaning, to getting food on the table. If that’s not hectic enough, parents and caregivers are also forced to navigate various complex systems across health, social, education, and early childhood services just to care for their kids. Those systems are frequently not designed with their needs and realities in mind, nor do these systems seamlessly communicate or coordinate efforts. One pediatric clinic in Alameda County found that after screening their pediatric patients for health and social needs, families needed help navigating services addressing food insecurity, housing insecurity, behavioral health needs, and child developmental delays. And also – they needed a better system to make those referrals for their patients. 

For families to best access necessary services, it is critical to have an effective and compassionate referral system. One that understands a family’s life challenges and circumstances, supports informed decision-making about their care, and efficiently tracks and secures referrals to ensure follow-up and completion of services. Health and social service providers play a crucial role by connecting children to services they need. These referral loops form a web of support that includes primary care, dental, behavioral health, specialty care, and community programs addressing nutrition, housing, and developmental needs. A recent survey of families with young children confirmed how important these referrals are, showing that parents and caregivers were more likely to sign up for food assistance programs if their pediatrician told them they were eligible. 

However, it’s not enough for providers to just make referrals. A truly effective system requires follow-up to “close the loop” and ensure a family was able to receive needed services. Imagine the relief of sharing concerns about your child’s health or development with a provider who not only listens but takes tangible steps to ensure that the recommended support is not lost in the bureaucratic shuffle or the daily struggle. Such a system not only acknowledges the systemic barriers placed on families and caregivers by distinct, and at times contradictory or confusing, policies and institutions, but works to eliminate and reduce the challenges parents and caregivers face in accessing services so that the goal of meeting the child’s health needs is achieved. 

This type of supported vision for Medi-Cal members may soon become a reality. In 2025, a follow-up will be required when children and youth get referred for crucial health care services and community resources recommended to them. Essentially, this will “close the loop” on recommended care and services to meet a child’s needs.  

However, even though a “Closed Loop Referral” policy has great potential, the design of systems and standards will be critical to ensuring its eventual success.  


Keep reading below to learn more on the upcoming shift towards Closed Loop Referrals in Medi-Cal and the recommendations Children Now has for a successful referral system. 

What’s the change? 

Change is on the horizon with the California Advancing and Innovating Medi-Cal (CalAIM) Initiative to improve the health of Medi-Cal populations by creating and closing referral loops. As part of the CalAIM Population Health Management initiative, “Closed Loop Referrals are defined as coordinating and referring the [Medi-Cal Managed Care Plan] member to available community resources and following up to ensure services were rendered.”  

Specifically, beginning in 2025, Medi-Cal Managed Care Plans (MCPs) will be required to close referral loops for their members made to/from health and community resources including: Enhanced Care Management and Community Supports providers; Community Health Workers (CHWs), peer counselors, and local community organizations; dental providers; California Children’s Services (CCS); Developmental services; CalFresh; WIC providers; county social service agencies; and specialty mental health and substance use disorder services. This transformative policy aims to streamline and improve the referral process, aligning with the State’s goals to enhance care quality, address disparities in children’s and maternity care, and boost mental health services. 

Why does it matter? 

A timely, quality, trusted, and completed referral makes the difference in ensuring a child gets the services/supports they need. It also provides the child’s provider and care team the information they need to appropriately follow-up on the child’s care and family’s needs. In fact, one major challenge with CalAIM implementation so far is that “Medi-Cal enrollees are turning down new services because they are being offered at the wrong time or by the wrong person.” That’s why it’s so important for children and families with Medi-Cal managed care, who need to get connected to the right care when they need it, have support through every step of the referral process. A helping hand with referrals means parents are less likely to lose valuable time chasing down information and following up on services that were recommended, or become overwhelmed trying to navigate programs and providers.  

Ultimately, the State can build an approach to referrals that fosters high-quality, efficient, community-based, and culturally-sensitive care that bridges gaps and ensures equitable outcomes for children in Medi-Cal managed care. However, creating a respectful and effective referral system that closes the loop on care will require intentional family-centered planning, infrastructure resources, trusted local partnerships, and clear policy direction. For lasting impact, ongoing monitoring efforts will be crucial, and holding Medi-Cal Managed Care Plans (MCPs) accountable for improved children’s outcomes will ensure the sustainability of positive changes. California joins at least two other states (Louisiana and North Carolina) at the vanguard of using referral systems that close the loop on care as a Medicaid managed care tool to improve health equity.  The lessons learned will be increasingly valuable as managed care plays an ever-important role in Medicaid programs across the country.    

What’s next? 

To help California prepare for a referral system that closes the loop on care for families, Children Now conducted extensive research and engaged in a variety of stakeholder conversations to provide insights into the current and potential future referral landscape. The findings are described in this issue brief, Closing the Referral Loop: Recommendations for Medi-Cal Referral Systems to Support Children and Families. The brief offers five key recommendations to ensure the success of Closed Loop Referrals for children and families in Medi-Cal: 

  1. Clear Definitions and Standards: Establish precise definitions and standards to guide the referral process. 
  2. Leverage Data and Integrate Technology: Utilize data and integrate technology to enhance the efficiency of the referral system. 
  3. Trusted Partnerships and Referral Pathways: Build and rely on trusted partnerships and established referral pathways. 
  4. Provider Training and Supports: Implement training and support mechanisms for healthcare providers involved in the referral process. 
  5. Resource and Monitor Referrals: Allocate resources and establish monitoring mechanisms to track and assess the success of referrals. 

Because the Closed Loop Referral policy does not take effect until 2025, it will be incredibly important for the State and stakeholders to prepare and partner throughout 2024. Children Now and our partners will be advocating for California to take the opportunity to invest in Closed Loop Referral systems that prioritize the needs of children and families, strengthening connections and communication between providers and the communities they serve.  

The State recently released the application for a funding opportunity (Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 3) that can be used, among other things, to support eligible entities (such as health providers, community-based organizations, and local government agencies) in the implementation of a closed-loop referral system. Applications are due February 15, 2024.