Learn About California Advancing and Innovating Medi-Cal (CalAIM)
About CalAIM
California Advancing and Innovating Medi-Cal (CalAIM) is a multiyear initiative, spanning from 2022 to 2027, by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of the Medi-Cal population by implementing broad delivery system, program and payment reforms across the Medi-Cal program.
The initiative leverages Medi-Cal as a tool to help address many of the complex challenges facing California’s most vulnerable residents, including individuals experiencing homelessness, children with complex medical conditions, justice-involved populations who have significant clinical needs and the growing aging population.
CalAIM has three primary goals:
Identify and manage member risk and needs through whole person care approaches and addressing social determinants of health
Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility
Improve quality outcomes, reduce health disparities and drive delivery system transformation and innovation through value-based initiatives, modernization of systems and payment reform
To better identify and manage member risk and needs for beneficiaries who may be challenged with medical and behavioral conditions, access to care , chronic illnesses and disabilities, DHCS is proposing a whole system, person-centered approach that will result in a better quality of life for our members as well as long-term cost savings and avoidance. Components of this system include:
A statewide population health management strategy
A statewide Enhanced Care Management (ECM) benefit
Implementation of optional Community Supports (formerly known as In Lieu of Services)
Implementation of incentive payments for plans and providers
Participation in the Serious Mental Illness (SMI)/Serious Emotional Disturbance (SED) demonstration
Required screening and enrollment for Medi-Cal prior to release from county jail
A pilot with full integration of physical health, behavioral health and oral health under one contracted entity in a county
A long-term plan for foster care children and youth
The major components of CalAIM build upon the success of previous federal waiver programs including, but not limited to, the Whole Person Care (WPC) pilot, Health Homes Program (HHP) and the Coordinated Care Initiative (CCI). Over the span of the initiative, services provided through WPC, HHP and CCI will be transitioned to CalAIM and made available to a larger portion of CalOptima’s membership.
The Program will address service gaps in these areas:
Short-Term Post-Hospitalization Housing
Provides members who do not have a residence and who have high medical or behavioral health needs to continue recovery immediately after exiting a facility
Day Habilitation Programs
Provides members with assistance in acquiring, retaining and improving the skills necessary to reside successfully at home and in their community
Personal Care and Homemaker Services
Provides members with assistance with Activities of Daily Living and Instrumental Activities of Daily Living
Medically Tailored Meals/Medically Supportive Food
Provides members with meals and nutrition services that help to achieve nutrition goals at critical times to help regain and maintain health
Sobering Centers
Provides members who are found to be publicly intoxicated with an alternative destination to an emergency department or jail
CalOptima, in collaboration with the Orange County Health Care Agency and other community partners, is working diligently on a seamless transition for current HHP and WPC beneficiaries, who were among the first to receive CalAIM benefits on January 1, 2022. For more information on the components of CalAIM, please visit the DHCS CalAIM website.
To become a provider for Cal Aim please visit Ca Care Association (https://www.cacareassociation.org/membership-benefits-care-provider)
