CalAIM Long-Term Care Carve-In
California is transforming Medi-Cal through several initiatives to continue to drive quality of care improvements, streamline and reduce complexity, and build upon equity-focused, data-driven, and whole-person care. To further CalAIM’s goals to standardize and reduce county-to-county differences, Medi-Cal managed care plans (MCPs) began covering and coordinating Medi-Cal institutional Long-Term Care (LTC) in all counties in 2023 in a phased approach by benefit type. The statewide managed LTC better integrates care across institutional and home- and community-based settings.
What the Carve-In means for Californians
On January 1, 2023, all MCPs became responsible for covering the following LTC benefit:
- Skilled Nursing Facility (SNF), both freestanding and hospital-based SNFs
On January 1, 2024, all MCPs became responsible for covering the following LTC benefits:
- Intermediate Care Facility for Developmentally Disabled (ICF/DD) Home
- Intermediate Care Facility for the Developmentally Disabled – Habilitative (ICF/DD-H) Home
- Intermediate Care Facility for the Developmentally Disabled – Nursing (ICF/DD-N) Home
- Adult Subacute Care
- Pediatric Subacute Care
Note: ICF/DD-Continuous Nursing Care (ICF/DD-CN) Homes are not subject to the LTC Carve-In policy.
More information for members can be found on the LTC Carve-In Member Information webpage.
Information by LTC Facility/Home
For more information and resources on the LTC Carve-In by facility/home type, visit the following webpages:
- Skilled Nursing Facility (SNF) Long-Term Care Carve-In
- Intermediate Care Facility for the Developmentally Disabled Long-Term Care Carve-In
- Subacute Care Long-Term Care Carve-In
Informational Webinars
Department of Health Care Services (DHCS) hosted educational webinars to support stakeholders with the LTC Carve-In implementation. Details and materials for the webinars can be found at the following link:
Managed Care Resources for LTC Providers
To support stakeholders with Carve-In implementation, DHCS developed a set of resources for LTC providers focused on key managed care operational areas to help enhance overall understanding of Medi-Cal managed care.
- Medi-Cal Authorizations LTC Resource
- Medi-Cal Billing and Payment LTC Resource
- Medi-Cal Eligibility and MCP Enrollment LTC Resource
Additional Resources
- CalAIM Managed Long Term Services and Supports & Duals Stakeholder Integration Workgroup
- California Long-Term Services and Supports Dashboard
- Transitional Care Services for Members with Long-Term Services and Supports Needs
- Automated Eligibility Verification System (AEVS) via the DHCS Provider Portal – where providers can find MCP enrollment information for members
Questions
Contact DHCS with any questions about the CalAIM LTC Carve-In at LTCTransition@dhcs.ca.gov.