California Advancing & Innovating Medi-Cal (CalAIM)

Overview

Enhanced Care Management (ECM) is a new statewide Medi-Cal benefit for the highest-need Medi-Cal enrollees. The benefit is intended to provide person-centered care management, primarily through in-person engagement where enrollees live, seek care, and choose to access services. ECM will address clinical and non-clinical needs of the highest-need enrollees through intensive coordination of health and health-related services.

ECM is available to the following “populations of focus:”

• Adults, children, and youth experiencing homelessness
• Adults, children, and youth at risk for avoidable hospital or emergency department utilization
• Adults, children, and youth with serious mental health or substance use disorder needs
• Adults, children, and youth who are incarcerated and transitioning to the community
• Adults living in the community and at risk of long-term care institutionalization
• Adult nursing facility residents transitioning to the community
• Children and youth enrolled in California Children’s Services (CCS) with additional needs beyond CCS
• Children and youth involved in child welfare
• Adults, children, and youth with intellectual or developmental disabilities
• Pregnant and postpartum individuals (birth equity population)

Additional information on Enhanced Care Management (ECM) is available here.

Resources

• DHCS – ECM Implementation Timeline & Updated Populations of Focus (December 2022)
• DHCS – Enhanced Care Management Policy Guide (December 2022)
• DHCS – ECM Billing and Invoice Guidance (January 2022)
• DHCS – CalAIM Data Sharing Authorization Guidance (March 2022)
• DHCS – Enhanced Care Management Fact Sheet
• Aurrera Health Group – Enhanced Care Management Provider Toolkit

Past Webinar & Office Hour Materials

• DHCS – Overview of Data Exchange and Reporting Requirements for ECM and Community Supports (December 2021) – Presentation
• DHCS – CalAIM ECM and Community Supports Provider Resources (January 2022) – Presentation and Recording
• DHCS – CalAIM ECM: A New Vision for Whole Person Care (June 2022) – Presentation
• DHCS – ECM and Community Supports in Rural California (June 2022) – Presentation and Recording
• DHCS Office Hours – Rural Implementation of ECM and Community Supports (July 2022) – Presentation and Recording
• DHCS Webinar – ECM and Community Supports Data Exchange Overview #2 (August 2022) – Presentation and Recording
• DHCS Office Hours – ECM and Community Supports Data Exchange Overview (August 2022) – Presentation and Recording
• DHCS Webinar – ECM and Community Supports Outreach and Engagement (August 2022) – Presentation and Recording
• DHCS Office Hours – ECM and Community Supports Outreach and Engagement (September 2022) – Presentation and Recording
• DHCS Webinar – ECM Long-Term Care Populations of Focus (September 2022) – Presentation and Recording
• DHCS Office Hours – ECM Long-Term Care Populations of Focus (September 2022) – Presentation and Recording
• DHCS Office Hours – ECM and Community Supports Implementation in Rural California (September 2022) – Presentation and Recording
• DHCS Webinar – Housing Supports via ECM and Community Supports (October 2022) – Presentation and Recording
• DHCS Office Hours – Housing Supports via ECM and Community Supports (October 2022) – Presentation and Recording
• DHCS Webinar – Data Sharing and Billing for ECM and Community Supports (November 2022) – Presentation and Recording
• DHCS Office Hours – Implementation of ECM and Community Supports in “New” Counties (November 2022) – Presentation and Recording
• DHCS Office Hours – How Organizations are Sharing Data for ECM and Community Supports (December 2022) – Presentation and Recording

Overview

Community Supports (formerly known as “In Lieu of Services”) are a new optional service provided by Medi-Cal managed care plans as cost-effective alternatives to traditional medical services or settings. Community Supports are designed to address health-related social needs and build upon previous successes in the Whole Person Care Program and Health Homes Program.

Medi-Cal managed care plans may opt to offer any of the following 14 Community Supports:

• Housing Transition Navigation Services
• Housing Deposits
• Housing Tenancy and Sustaining Services
• Short-Term Post-Hospitalization Housing
• Recuperative Care (Medical Respite)
• Day Habilitation Services
• Caregiver Respite Services
• Nursing Facility Transition/Diversion to Assisted Living Facilities
• Community Transition Services/Nursing Facility Transition to a Home
• Personal Care and Homemaker Services
• Environmental Accessibility Adaptations (Home Modifications)
• Medically Supportive Food/Medically Tailored Meals
• Sobering Centers
• Asthma Remediation

Additional information on Community Supports is available here.

Resources

• DHCS – Community Supports Policy Guide (December 2022)
• DHCS – Community Supports Billing and Invoice Guidance (January 2022)
• DHCS – Community Supports Non-Binding Pricing Guidance
• DHCS – CalAIM Data Sharing Authorization Guidance (March 2022)
• DHCS – Community Supports Fact Sheet
• Aurrera Health Group – Community Supports Explainer

Past Webinar & Office Hours Materials

• DHCS Webinar – Overview of Data Exchange and Reporting Requirements for ECM and Community Supports (December 2021) – Presentation
• DHCS Webinar – CalAIM ECM and Community Supports Provider Resources (January 2022) – Presentation and Recording
• DHCS Webinar – Community Supports Spotlight: Medically Tailored Meals (May 2022) – Presentation and Recording
• DHCS Webinar – Community Supports Spotlight: Sobering Centers and Day Habilitation (June 2022) – Presentation and Recording
• DHCS Webinar – ECM and Community Supports in Rural California (June 2022) – Presentation and Recording
• DHCS Webinar – Community Supports Spotlight: Asthma Remediation and Environmental Accessibility Adaptations (July 2022) – Presentation and Recording
• DHCS Office Hours – Rural Implementation of ECM and Community Supports (July 2022) – Presentation and Recording
• DHCS Webinar – ECM and Community Supports Data Exchange Overview #2 (August 2022) – Presentation and Recording
• DHCS Office Hours – ECM and Community Supports Data Exchange Overview (August 2022) – Presentation and Recording
• DHCS Webinar – Community Supports Spotlight: Recuperative Care and Short-Term Post-Hospitalization Housing (August 2022) – Presentation and Recording
• DHCS Webinar – ECM and Community Supports Outreach and Engagement (August 2022) – Presentation and Recording
• DHCS Office Hours – ECM and Community Supports Outreach and Engagement (September 2022) – Presentation and Recording
• DHCS Webinar – Community Supports Spotlight: Nursing Facility Diversion (September 2022) – Presentation and Recording
• DHCS Webinar – Community Support Spotlight: Housing Navigation, Tenancy Supports, and Deposits (October 2022) – Presentation and Recording
• DHCS Office Hours – Housing Supports via ECM and Community Supports (October 2022) – Presentation and Recording
• DHCS Webinar – Community Supports Spotlight on Personal Care, Homemaker Services, and Caregiver Respite (November 2022) – Presentation and Recording
• DHCS Webinar – Data Sharing and Billing for ECM and Community Supports (November 2022) – Presentation and Recording
• DHCS Office Hours – Implementation of ECM and Community Supports in “New” Counties (November 2022) – Presentation and Recording
• DHCS Office Hours – How Organizations are Sharing Data for ECM and Community Supports (December 2022) – Presentation and Recording
• DHCS Webinar – Community Supports Spotlight on Children & Youth (December 2022) – Presentation and Recording

Overview

California seeks to address poor health outcomes among justice-involved adults and children by ensuring continuity of coverage after incarceration. CalAIM builds upon services and programming provided in criminal justice settings under the Whole Person Care Program and Medication Assisted Treatment (MAT) Programs. Strategies are focused on establishing pre-release Medi-Cal enrollment and delivering key services to support successful community reentry.

CalAIM Justice-Involved components include:

• Enrollment of eligible individuals in Medi-Cal prior to release from county jails or youth correctional facilities
• Engagement with individuals meeting specified clinical criteria (e.g., pregnant or chronically ill) in the 90 days prior to release to stabilize their health and prepare for successful community reentry
• Providing “warm handoffs” to providers to ensure individuals who require health and behavioral health services, medications, and other medical supplies have what they need upon reentry
• Offering intensive, community-based care coordination for individuals at reentry, including through Enhanced Care Management (ECM)
• Making Community Supports available upon reentry if offered by their managed care plan

Stakeholder Working Group Information & Materials

DHCS has established a CalAIM Justice-Involved Advisory Group to provide input on policy and implementation matters. Stakeholders include leaders and representatives from key sectors, including counties, correctional settings, health plans, consumers, and policy organizations. While participation is limited to Advisory Group members, DHCS welcomes the public to attend meetings.

• Meeting #1: October 28, 2021 – Presentation
• Meeting #2: November 23, 2021 – Presentation
• Meeting #3: January 7, 2022 – Presentation
• Meeting #4: January 27, 2022 – Presentation
• Meeting #5: February 24, 2022 – Presentation
• Meeting #6: March 24, 2022 – Presentation
• Meeting #7: May 26, 2022 – Presentation
• Meeting #8: July 28, 2022 – Presentation
• Meeting #9: December 1, 2022 – Presentation
• Meeting #10: February 23, 2023 – Presentation

Additional information on the CalAIM Justice-Involved Advisory Group is available here.

Supporting Materials

• PCG – Justice-Involved Capacity Building Grant Round 2 Application (Due March 31, 2023)

Resources

• DHCS – CMS Justice-Involved Initiative Approval Letter and Special Terms & Conditions (December 2022)
• DHCS – ACWDL 22-27 on Mandatory Pre-Release Medi-Cal Application Process for Inmates of Correctional Facilities (November 2022)
• DHCS – ACWDL 22-26 on Suspension of Medi-Cal Benefits of Inmates, Redetermination Requirements, and Timeline Guidance (October 2022)
• DHCS – Justice-Involved Population Fact Sheet
• DHCS – Issue Brief: Strategies for Conducting Pre-Release Medi-Cal Enrollment in County Jails and Youth Correctional Facilities

Overview

Under CalAIM, Medi-Cal managed care plans will be required to implement a whole-system, person-centered strategy that includes assessments of each enrollee’s health risks and health-related social needs, focuses on wellness and prevention, and provides care management and care transitions across delivery systems and settings. PHM components are slated to go-live beginning in 2023.

Stakeholder Working Group Information & Materials

• Meeting #1: March 18, 2022 – Presentation
• Meeting #2: April 26, 2022 – Presentation
• Meeting #3: May 31, 2022 – Presentation
• Meeting #4: July 27, 2022 – Presentation
• Meeting #5: September 29, 2022 – Presentation
• Meeting #6: October 24, 2022 – Presentation
• Meeting #7: December 5, 2023 – Presentation
• Meeting #8: February 8, 2023 – Presentation

Resources

• DHCS – Population Health Management Policy Guide (December 2022)
• DHCS – Population Health Management Frequently Asked Questions (December 2022)
• DHCS – Population Health Management Program Readiness Deliverable Template (September 2022)
• DHCS – Final Population Health Management Strategy and Roadmap (July 2022)
• DHCS – Population Health Management Fact Sheet
• DHCS – CalAIM Corner on Population Health Management
• DHCS – PHM Service Webinar, May 2022 – Presentation and Recording

Overview

CalAIM initiatives, coupled with the state’s focus on children’s health quality and equity, seek to transform the Medi-Cal system to improve the health and well-being of enrollees, including the many children and families served by Medi-Cal. Opportunities exist to ensure Medi-Cal-enrolled children and youth have access to person-centered health and health-related services focused on prevention, wellness, and improved quality of life and health.

Stakeholder Working Group Information & Materials

DHCS has established a CalAIM Children & Youth Advisory Group to offer regular input on key policy and program design decisions on CalAIM components that impact children and youth. Near-term efforts will focus on Population Health Management (PHM), Enhanced Care Management (ECM), and Community Supports components.

• Meeting #1: December 17, 2021
• Meeting #2: January 28, 2022
• Meeting #3: March 11, 2022
• Meeting #4: April 13, 2022
• Meeting #5: May 23, 2022
• Meeting #6: July 18, 2022
• Meeting #7: August 15, 2022
• Meeting #8: September 19, 2022

Resources

• DHCS – Medi-Cal Strategy to Support Health and Opportunity for Children and Families

Overview

DHCS seeks to provide enhanced monitoring and oversight of local health department administration of the California Children’s Services (CCS) Program to ensure continuous and quality care for CCS children. Under this CalAIM component, DHCS will develop and implement a strategic compliance program that includes specific goals, metrics, performance measures, and milestones. County CCS Oversight & Monitoring is slated to go-live in July 2023.

Stakeholder Working Group Information & Materials

To solicit stakeholder feedback and input on the development and implementation of CCS Oversight & Monitoring, DHCS has created a County CCS Oversight & Monitoring Advisory Group.

• Meeting #1: January 31, 2022 – Presentation
• Meeting #2: March 28, 2022 – Presentation
• Meeting #3: April 25, 2022 – Presentation
• Meeting #4: May 23, 2022 – Presentation
• Meeting #5: June 30, 2022 – Presentation
• Meeting #6: July 25, 2022 – Presentation
• Meeting #7: September 26, 2022 – Presentation
• Meeting #8: November 7, 2022 – Presentation
• Meeting #9: December 19, 2022 – Presentation
• Meeting #10: January 30, 2023 – Presentation
• Meeting #11: March 13, 2023 – Presentation

Additional information on the CCS Program, including CCS-related CalAIM activities, is available here.

Overview

The Providing Access and Transforming Health (PATH) Initiative, approved under the state’s Section 1115 Waiver, provides funding to counties, providers, community-based organizations, and other local entities to expand capacity to implement key CalAIM components, including Enhanced Care Management and Community Supports, statewide.

PATH includes four separate initiatives:

• Whole Person Care (WPC) Services and Transition to Managed Care Plans (MCPs) Initiative – Limited to former WPC Lead Entities; launched January 2022
• Technical Assistance Initiative – Funding available to providers of ECM and Community Supports; launched February 2023
• Collaborative Planning & Implementation Initiative – Regional collaborative groups to facilitate planning and implementation of CalAIM components; launched January 2023
• Capacity & Infrastructure Transition, Expansion, and Development (CITED) Initiative – Funding to enable the transition, expansion, and development of ECM and Community Supports capacity and infrastructure; launched August 2022

PATH will utilize a third-party administrator (TPA) to develop, coordinate, and implement various PATH-related activities and initiatives.

PATH Third-Party Administrator (TPA): Public Consulting Group

• TPA Home Page
• Capacity, Infrastructure Transition, Expansion, and Development (CITED) Initiative
  • Round 1A Awardees – $119 million awarded in January 2023
  • Round 1B Awardees – $88.5 million awarded in March 2023
  • Round 2 Opportunity – Closes May 31, 2023
• Collaborative Planning and Implementation Initiative
  • Collaborative Directory
  • Collaborative Participant Registration
• Justice-Involved Capacity Building Initiative
• Technical Assistance Marketplace
  • Shop TA Marketplace

Supporting Materials

• DHCS – Collaborative Planning & Implementation Initiative Guidance Memo (May 2022)
• DHCS – CITED Guidance Memo (July 2022)
• DHCS – Technical Assistance Marketplace Memo (November 2022)

Resources

• DHCS – Overview Webinar on PATH

Past Webinar Materials

• DHCS – PATH and Incentive Payment Programs Overview (December 2021) – Presentation
• DHCS – Detailed Update on PATH Program Design (January 2022) – Presentation
• DHCS – PATH CITED Application Walkthrough and Q&A (September 2022) – Presentation