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The provided materials present an opinion piece by National Urban League CEO Marc H. Morial, who proposes a policy blueprint focused on improving economic affordability for working families. Additionally, the pages feature historical archives from the New Journal and Guide that chronicle decades of civil rights activism, including school desegregation protests, church bombings, and the regional establishment of the Urban League. Alongside these historical accounts, the publication highlights modern advertisements and organizational details for the Hampton Roads Community Foundation. Ultimately, the texts weave together contemporary economic advocacy with historical reflections on racial justice and community support.

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By Marion Apio, California Local News Fellow

CalAIM offers housing and health care support through Medi-Cal, but fragmented health-plan rules, administrative barriers and limited awareness can make those benefits difficult for vulnerable Californians to access.

Marion Apio reported this story while participating in the USC Annenberg Center for Health Journalism’s 2026 California Health Equity Fellowship.

By Marion Apio | California Local News Fellow

California’s largest Medi-Cal transformation—California Advancing and Innovating Medi-Cal, or CalAIM—was designed to connect residents experiencing homelessness, trauma, and chronic illness directly to health care and social services. The statewide initiative allows healthcare providers to bill Medi-Cal for intensive, field-based care coordination, bringing doctors, social workers, and housing navigators directly to unsheltered residents where they live.

Yet despite CalAIM’s ambitious promise to fund care outside clinic walls, health care providers say many unhoused Angelenos still face steep barriers to accessing these services. Health plans have not always been aligned on which services to offer, creating a patchwork of coverage across the state. For patients, those differences can mean delays in approvals, changes in available services or additional paperwork before care or housing assistance can move forward.

“Under CalAIM, there has been this incredible ability to pay for certain things that are helpful to anyone experiencing homelessness,” said Margot Kushel, Professor of Medicine, UCSF Director of UCSF Benioff Homelessness and Housing Initiative. “We can pay for things like street medicine. We can pay for enhanced case management, housing tenancy support services to keep people in their housing, and things like first and last month’s rent to help people.”

“Pathways to housing are highly effective, she added, “but we need more of them. The problem is not so much that it doesn’t work for the people it’s serving; it’s that it’s under-resourced for the people it’s serving, and most people don’t get it.”

Across Los Angeles County, community organizations and street medicine teams report spending significant hours navigating complex enrollment portals and billing hurdles that delay care for residents in critical need.

More than four years after California launched CalAIM to use Medi-Cal funding for nonmedical needs such as housing, food and case management, overall Medi-Cal enrollment has declined from about 15 million in 2023 to 13,910,180 in April 2026, according to the California Department of Health Care Services. CalAIM is not a separate insurance program and does not have its own enrollment or withdrawal process; people enroll in Medi-Cal and may qualify for CalAIM services based on their needs.

For 53-year-old Alfred Flores, connecting with a CalAIM-funded street medicine team along the Los Angeles River proved transformative.

Flores was only 17 when he first entered California’s prison system as an adult.

Raised around family members involved in gang life and without financial resources for a private legal defense, the young Flores cycled through juvenile halls and state prisons, including the California Institution for Men in Chino and a correctional facility in Delano.

“I was tried as an adult and we didn’t have any lawyers or nothing,” Flores said. “So, yeah, I was misjudged, you know. But it is what it is.”

Decades after his release, the consequences of incarceration lingered. Diagnosed with severe post-traumatic stress disorder, Flores struggled to navigate crowded public spaces and complex social service systems. Unhoused and contending with uncontrolled diabetes, his health rapidly deteriorated.

Flores’ path changed when he met Artie Vasquez, a community health worker and case manager with St. John’s Community Health. Vasquez helped Flores navigate and access medical care through case management services provided under CalAIM’s Enhanced Care Management benefit — and, just as importantly, helped him secure an apartment in Inglewood using Medi-Cal dollars.

Enhanced Care Management (ECM) — a Medi-Cal benefit that provides intensive, individualized care coordination for members with complex needs — pairs members with a care manager who coordinates physical, behavioral and social services, while Community Supports address needs such as housing instability, nutrition and chronic-condition management.

“I can go in and out of my house. I can shower whenever I want. Use the restroom whenever I want. It’s my house, you know,” Flores said.

Artie Vasquez, who overcame similar life challenges before becoming a case manager, said the program provides the scaffolding needed for individuals leaving incarceration to successfully transition back into society.

Medi-Cal covers close to 14 million residents statewide. In Los Angeles County, where over 70,000 people experience homelessness on any given night, connecting high-need populations to social safety nets remains an operational challenge.

CalAIM addresses these challenges through Community Supports, or non-medical interventions, such as move-in security deposits, housing navigation, and modifications to make housing accessible.

For frontline clinics, the growth in such services represents a massive shift in how care is delivered.

Christina Guevara, an Enhanced Care Management program manager at St. John’s Community Health has watched this safety-net infrastructure expand over six years.

In just the past three years, St. John’s CalAIM caseload has surged from under 1,000 patients to nearly 1,600, serving a community that is roughly 55% Latinos and White as well as 26% Black, according to Monica Cotom, director of CalAIM at St. John’s Community Health.

Guevara noted that language barriers, low health literacy, and a lack of support systems frequently cause low-income patients to drop out of care. She said that is especially true for older patients who may struggle to navigate complex medical instructions or question a doctor’s diagnosis.

In one instance, St. John’s case managers worked with an unhoused domestic violence survivor living in a shelter who avoided medical visits out of fear of being located by an abuser. Through biweekly phone calls, virtual support groups, and accompanied clinic visits, case managers helped the survivor secure permanent housing and reduce his hemoglobin A1C level from a dangerous 14% down to 7% over an 18-month period.

Yet, administrative breakdowns regularly interrupt patient care.

“The health plans have never been quite aligned for this program across the board, and so that’s been the barrier,” said Cotom. “We have to fluctuate with whatever the health plans need, and so that makes it hard.”

Because each Medi-Cal managed care plan operates with its own documentation requirements, billing systems, and approval rules, caseworkers must constantly adapt to conflicting administrative processes. For unhoused patients, these hurdles translate directly into real-world delays. For unhoused clients, bureaucratic errors can pause housing placements for months.

In Inglewood, city officials acknowledge that awareness remains a barrier.

Roberto Chavez, HUD programs manager for the City of Inglewood, called CalAIM an “untapped resource,”  and noted that municipal governments currently lack public education campaigns to connect eligible residents with the state program.

“Not too many people are aware of that,” Chavez said. “Again, that requires some education of the residents and people experiencing homelessness, as well as any staff that’s in charge of identifying resources.”

When asked what the city is doing to publicize CalAIM to unhoused residents, Chavez said the city relies on partner non-profits rather than municipal outreach.

“Nothing at the current moment,” Chavez said. “But we direct folks to the St. Margaret’s Center, and they make folks aware of the CalAIM program, as well as the South Bay Cities Council of Governments.”

Addressing why local agencies struggle to roll out CalAIM seamlessly, Kushel called it a nearly impossible task.

“When you’re frantically trying to plug up holes from 50 years of failed policies at every level of government in a wildly unequal country where there’s rampant income inequality … it’s also really an impossible task,” Kushel said, adding that local authorities are “trying to put fingers into sort of a leaking bucket, and it’s very hard to do that.”

Ashley Watson was offered CalAIM services in June 2025 while living in her car in Los Angeles. Working with Stephanie Ortiz, a case manager, Watson secured several jobs to raise her monthly rental budget from $1,200 to $2,000. When bad credit led to apartment rental rejections, Ortiz assisted in securing a guarantor.

However, during the application process, an administrative error caused Watson’s Medi-Cal coverage to terminate unexpectedly. It took nearly a month of staff effort to restore her coverage before security deposit and move-in funding could be released. Watson moved into her apartment in November 2025 and officially graduated from the program in June 2026.

Mary Vargas, Community Supports program manager at St. John’s, said administrative gaps leave the most vulnerable clients behind.

“A lot of people don’t understand why and feel powerless in their own care,” Vargas said. “If you’re powerless, have a chronic condition, and are alone with no support, your health significantly declines.”

Guevara reported that rising fears around immigration status and potential scams have led members to decline home visits or ignore phone calls from case managers. To support clients facing these anxieties, St. John’s transitioned many in-person check-ins to virtual appointments.

DHCS acknowledged that some immigrant families are experiencing fear  about data-sharing with federal agencies that might use the information in enforcement actions. The department said it does not track whether people decline CalAIM services because of those concerns, but encouraged eligible Medi-Cal members to maintain their coverage and continue seeking care.

Vasquez noted that individuals released from state prisons face delays of 30 to 90 days before their active Medi-Cal status is reinstated.

Those delays force clinics to rely on sliding-scale fees based on income –which many newly released participants do not have –while unhoused individuals without physical addresses often rely on family members’ addresses to keep their mail delivered and avoid losing coverage.

But for those who get past the hurdles and receive services, the results can be life changing.

Flores is now enrolled in online business and culinary arts classes through Coastline College, working toward his long-term goal of financial independence.

“Before, I didn’t know how to go about things, but now with my medication, my doctors, and my case manager who always calls to see if I’m doing okay, it has helped me a lot—and I can trust the system,” Flores said.

By Marion Apio, California Local News Fellow

Marion Apio reported this story while participating in the USC Annenberg Center for Health Journalism’s 2026 California Health Equity Fellowship.

For 70-year-old Gilbert Ramirez, the intersection of medical care and supportive housing proved lifesaving.

First sent to prison at 25, Ramirez spent decades cycling through nine separate sentences and three decades of parole supervision before finally completing parole seven years ago.

“I’ve been told what to do, man, for all my adult life,” Ramirez said. “I had nine turns on one number, and finally they gave my life back. So now I’m a free citizen.”

While incarcerated, he and his wife separated. After returning to society, he lost his daughter to cancer, was shot, and was left partially paralyzed and unhoused.

Surviving on the street, Ramirez fell into a heavy fentanyl addiction. For seven years, severe, open wounds flared on both of his legs—wounds he had no way of healing while living unhoused.

As the infections worsened, his weight plummeted to 95 pounds.

Compounding challenges for seniors who are unhoused

For people like Ramirez, the dangers of living on the street compound with age. Chronic illnesses become harder to manage, mobility declines and minor health problems can quickly escalate into medical emergencies without a stable place to recover or store medications. Increasingly, this vulnerable population includes seniors falling into homelessness for the first time after a lifetime of low-wage, physically demanding work.

“We have a large proportion of seniors experiencing homelessness—about 43 percent who had never been homeless before after the age of 50,” said Margot Kushel, professor of medicine, UCSFDirector of UCSF Benioff Homelessness and Housing Initiative

Eight months ago, outreach workers with People Assisting The Homeless—a nonprofit housing and social services agency—moved Ramirez into the Los Angeles Inn in Inglewood. They did so under an L.A. County-led initiative that brings unsheltered residents indoors by placing them inmotels converted into interim housing. It also connects clients with wraparound healthcare and case management.The effort primarily receives funding through L.A. County’s Measure A sales tax, which aims to create a direct pipeline from street encampments to permanent housing.

By the time Ramirez connected with Carrie Kowalski last November, a senior physician assistant with Venice Family Clinic, the wounds on both of his legs were deep, painful, and itchy. Kowalski cleaned and wrapped the wounds and provided Ramirez with naloxone nasal spray—an emergency overdose reversal drug – along with fentanyl test strips and buprenorphine starter supplies, a medication used to treat opioid addiction.

“It’s good, I ain’t now underweight,” Ramirez said about the services he receives under Pathway Home. “They offer me medicine. They come and, you know, give you everything. Whatever I need—a doctor, food, a bed, water, and everything I never had before.”

From August 2023 to August 5, 2026, Pathway Homehad moved 2,361 people into interim housing, while 892 had moved into permanent housing, according to Los Angeles County. The county said the biggest barrier to moving people from interim to permanent housing is the shortage of affordable permanent homes.

Pathway Home’s mission is to reach encampments throughout L.A. County and link people to permanent housing, said Courtney Reed, associate director at PATH.

“We operate in what we call a trauma-informed care model,” Reed said.

The Los Angeles County’s Pathway Home budget for fiscal year 2026-27 is $59.5 million. The funding includes $24.4 million from Measure A, $19.8 million in Measure H carryover, $13.8 million in state Encampment Resolution Fund carryover and $1.5 million from the county Department of Mental Health, according to information provided by the county in an email. In April 2024, the county also received a $51 million grant from the state of California to expand the Pathway Home program.

Countywide, the number of unhoused adults ages 55 and older rose nearly 5 percent, from 18,212 in 2025 to 19,104 in 2026, accounting for about 26% of the county’s 73,040 unhoused residents. Black residents continue to be disproportionately represented among the people experiencing homelessness, accounting for 21,822 people of the unhoused population within the Los Angeles Continuum of Care, according to the 2026 Greater Los Angeles Homeless Count.

A shortage of affordable housing has limited options for the unhoused in Inglewood

In Inglewood, Pathway Home teams have moved 54 people into temporary housing in motels, according to the mayor’s office. While experts call this placement critical for vulnerable seniors, city officials clarified Inglewood is strictly a logistical partner.

“We have no funding obligation, Pathway Home Initiative is funded by the County of Los Angeles,” said Roberto Chavez, Inglewood’s HUD programs manager. “The city is a partner.”

However, transitioning people into permanent housing has also become more difficult in Inglewood, where the city’s housing voucher program is frozen under a “designated shortfall” from the U.S. Department of Housing and Urban Development because federal funding failed to match local rent increases.

“The housing authority has spent its annual allocation, and HUD is monitoring our finances,” Chavez said. “The result is we’re not able to issue more vouchers to families to get housing.”

While homelessness continues to trend downward in Inglewood—where the unsheltered population dropped from a peak of 751 individuals in 2022 to 290 in 2026—countywide data masks a growing crisis among older and Black residents.

Challenges for seniors who are unhoused

By the time outreach workers connected with Jacqueline Thomas last November, the 67-year-old was hauling an oxygen tank across La Brea Avenue while managing a heart condition, chronic obstructive pulmonary disease, diabetes, and a daily regimen of 13 prescription pills—all while living out of her car.

A 1976 graduate of Inglewood High School, Thomas’s life unraveled a decade ago after she lost her job. Faced with fixed income limits and rising housing costs across L.A. County, strain over rent money eventually frayed family ties, leading her to choose the streets over an unstable living situation.

For 10 years, Thomas parked her car outside businesses along La Brea Avenue to sleep. She let other unhoused neighbors stay inside with her for protection, but she could not avoid constant street harassment and theft. During one incident, someone stole $1,000 from her on the sidewalk.

A decade of exposure took a permanent toll on her body.

“All these health issues I have now, I didn’t have,” Thomas said. “I got them all out here in the streets.”

Six months after moving into a private room through Pathway Home, Thomas finally has reliable electricity to power her oxygen machine and blood pressure monitor, store her heart medication in a refrigerator, and manage her health.

“Housing is an intervention to help with vascular problems—like leg swelling and open wounds from sleeping sitting up—because now our patients have a bed to elevate their legs and sleep,” said Kowalski, who has operated a mobile clinic van since December 2020. “From a medical standpoint, we can provide care, but housing is the key intervention to actually get people better.”

Homelessness advocates point to L.A. County’s high cost of living and the severe gap between fixed disability payments and local rents as key drivers fueling the region’s homelessness crisis.

In an emailed statement, the Inglewood Mayor’s Office cited the shelter operation at Hollywood Inn Suites, a converted motel on Century Boulevard, as a key local success in resolving encampments.

The city said its Pathway Home partnership with Los Angeles County housed 54 people who had been living on the streets. It is also exploring motel master leasing and said it would consider adding a homeless services coordinator, funded through Los Angeles County’s Measure A, in June 2026.

When discussing the types of housing initiatives like Pathway Home that place seniors into interim housing, Kushel emphasizes that a standard apartment is not enough since older adults need specific physical adaptations.

“A lot of the issues we’re having is just the physical design of whether there’s infrastructure for people who can’t climb stairs,” Kushel said. “There’s a physical design aspect like, are there grab bars, non-slip surfaces and night lights.”

For Ramirez and Thomas, moving off the streets into stable housing has allowed them to focus on long-term recovery, healthcare, and personal goals.

Ramirez, who rides his bicycle up to 100 miles a week, said he is rebuilding his strength while gathering the medical records needed to secure a housing voucher for a local senior complex through Pathway.

His dream is to one day reunite with his 23 grandchildren and 12 great-grandchildren.

“I just want to be with my grandkids, raise my great-grandkids, and jam with them, you know what I mean?” Ramirez said. “Being out on the street was rough, just fighting all the time. But since I’ve been here, you know, it’s been all right. I’m home.”

For Thomas, months inside interim housing under Pathway Home have provided a secure environment to manage her health. With her medical needs finally managed and her daily living environment secure, she is now looking toward the future—hoping to acquire a computer and take tax preparation courses to build new job skills.

It is a sharp departure from her years spent struggling just to survive on the streets.

“I’m not a hopeless case,” Thomas said. “This is just my new way of living, and I’m adjusting to it.”

Marion Apio

Marion Apio is a multimedia journalist from Uganda currently based in Inglewood reporting for the Observer Group Newspaper of Southern California in Los Angeles. She pursued journalism to make information more accessible—especially for underserved communities like the one she grew up in. Her reporting focuses on access to basic resources necessary to advance human rights, education, health and with a strong interest in solutions journalism that highlights working models addressing community-level challenges.

She is a California Local News Fellow, USC California Health Equity Fellow and Widening the Pipeline Fellow with National Press Foundation. Marion has reported for Richmond Confidential, Oakland North, Bloomberg, and has also worked with the Investigative Reporting Program at UC Berkeley on issues related to journalist safety and human rights.