Background

The California Advancing and Innovating Medi-Cal (CalAIM) Initiative seeks to transform and align all elements of Medi-Cal into a standardized, simplified system focused on helping enrollees live healthier lives. CalAIM builds upon the successes of several statewide programs, including the Whole Person Care (WPC) Program, and shifts the Medi-Cal program to a population health approach that works to deliver more equitable, coordinated, and person-centered care. The California Department of Health Care Services (DHCS) secured from the Centers for Medicare and Medicaid Services (CMS) approval for the CalAIM Section 1115 Demonstration and CalAIM Section 1915(b) Waiver on December 29, 2021. CalAIM will be operational through December 31, 2026.

Timelines

Upcoming Webinars & Office Hours

  • Housing Supports via ECM and Community Supports Webinar – October 13 at 1:30 pm – Registration
  • Community Supports Spotlight: Housing Services Webinar – October 20 at 1:00 pm – Registration
  • Housing Supports via ECM and Community Supports Office Hours – October 27 at 3:00 pm – Registration

CalAIM Initiative Components

Below, CHEAC highlights important information and upcoming advisory group meetings specific to CalAIM topics and components of most interest to local health departments.

(Please note: The components detailed below are not exhaustive and do not represent all CalAIM activities and programs.)

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:”

  • Individuals and families experiencing homelessness
  • Adults, youth, and children who are high utilizers of avoidable emergency department, hospital, or short-term skilled nursing facility services
  • Adults with serious mental illness or substance use disorder
  • Children and youth with serious emotional disturbance, identified to be at clinical high risk for psychosis or experiencing a first episode of psychosis
  • Adults and youth who are incarcerated and transitioning to the community
  • Adults at risk of institutionalization and eligible for long-term care
  • 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 (including those with a history of involvement in welfare and foster care up to age 26)

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

Resources

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

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

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

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.

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

Supporting Materials

Resources

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

Resources

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

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 – Registration
  • Meeting #8: October 24, 2022 – Forthcoming
  • Meeting #9: November 21, 2022 – Forthcoming
  • Meeting #10: December 19, 2022 – Forthcoming

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; go-live anticipated Q1 2022
  • Technical Assistance Initiative – Funding available to providers of ECM and Community Supports; go-live anticipated Q3 2022
  • Collaborative Planning & Implementation Initiative – Regional collaborative groups to facilitate planning and implementation of CalAIM components; go-live anticipated Q3 2022
  • Capacity & Infrastructure Transition, Expansion, and Development (CITED) Initiative – Funding to enable the transition, expansion, and development of ECM and Community Supports capacity and infrastructure; go-live anticipated Q3 2022

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

PATH Third-Party Administrator: Public Consulting Group

Supporting Materials

Resources

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

In addition to the above CalAIM components, DHCS will begin covering Community Health Worker (CHW) services as a Medi-Cal benefit beginning July 1, 2022. This additional benefit is anticipated to support many of the CalAIM services and components. Additional information on CHWs as a Medi-Cal benefit is available here.

Additional Resources