CMS Approves CalAIM, HCBS Initiatives

The U.S. Centers for Medicare and Medicaid Services (CMS), under the U.S. Health and Human Services Agency, recently granted approval of California’s sweeping health and human services initiatives. On December 29, CMS signed off on the state’s sweeping “California Advancing and Innovating Medi-Cal” (CalAIM) initiative, consisting of two federal waivers – the Section 1115 Medicaid Demonstration Waiver and the 1915(b) Managed Care Waiver – and several state plan amendments.

CalAIM seeks to shift Medi-Cal to a population health approach by prioritizing prevention, addressing social drivers of health, and transforming services for individuals who have been historically under-resourced and marginalized. CalAIM builds upon successes of previous pilot programs, including the Whole Person Care (WPC) Program, and aligns how care is provided across delivery systems.

CMS approved new, statewide Medi-Cal services to help keep individuals healthy and in the community. Notably, these components include:

  • Enhanced Care Management – This new service seeks to address clinical and non-clinical needs of the highest-need Medi-Cal enrollees through intensive coordination of health and health-related services. Enrollees will be met primarily through in-person engagement where they live, seek care, or choose to access services.
  • Community Supports – This optional benefit provides new statewide services covered by managed care plans as medically appropriate alternatives to traditional medical services or settings, including assistance with housing supports, caregiver respite, food insecurity, and transitioning from the nursing home to the community.

State officials, including those with the Department of Health Care Services (DHCS), continue to work with federal officials on several aspects and components of CalAIM. The state’s proposed justice-involved youth and adult initiative and traditional and natural healer proposals have yet to receive final approval from CMS.

CMS additionally granted conditional approval of California’s Home- and Community-Based Services (HCBS) spending plan this week. The state’s CalAIM initiative is designed to complement the state’s HCBS plan. HCBS will additionally draw down federal funding appropriated through the American Rescue Plan Act (ARPA) Providing Access and Transforming Health (PATH) component. PATH is anticipated to provide funding to counties, providers, and community-based organizations to support capacity building as they work to implement and scale ECM and Community Supports services. PATH will also support justice-involved adults and youth by sustaining pre- and post-release services.

A full press release announcing the CMS approval from DHCS is available here.