California Advancing and Innovating Medi-Cal
California Advancing and Innovating Medi-Cal (CalAIM), is a multi-year initiative by DHCS to improve the quality of life and health outcomes of our population by implementing broad delivery system, program and payment reform across the Medi-Cal program. The major components of CalAIM build upon the successful outcomes of various pilots (including but not limited to the Whole Person Care Pilots, Health Homes, and the Coordinated Care Initiative) from the previous federal waivers and will result in better quality of life for Medi-Cal members as well as long-term cost savings/avoidance.
CalAIM has three primary goals:
- Identify and manage member risk and need 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; and
- Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems and payment reform.
DHCS formally released the CalAIM proposal on October 29, 2019, at the Stakeholder Advisory Committee (SAC) and Behavioral Health Stakeholder Advisory Committee (BH-SAC) meetings.
Throughout the remainder of 2019 and 2020, DHCS will conduct extensive stakeholder engagement for both CalAIM and the renewal of the federal authorities under which Medi-Cal operates (i.e. 1115 and 1915b waivers).
Due to the comprehensive scope of the CalAIM initiative, stakeholder engagement is critical. There are many ways to stay involved and engaged during the current planning and policy development phase. Additional information about ways to stay involved can be found in this CalAIM Stakeholder Engagement memo.
While the majority of CalAIM issues will be discussed through the CalAIM workgroups, some will be presented for discussion during the SAC, BH-SAC, and other DHCS sponsored stakeholder meetings. This CalAIM Proposals and Stakeholder Engagement document takes each component outlined in the CalAIM proposal and provides more information about stakeholder engagement opportunities and venues.
Please subscribe to DHCS' stakeholder email service to receive CalAIM updates and information about upcoming stakeholder meetings. For other comments, questions, or concerns, please contact CalAIM@dhcs.ca.gov.
Effective January 1, 2021, DHCS will carve in long-term care and coverage of transplants to become the responsibility of all Medi-Cal managed care plan model types, and will carve out the Multipurpose Senior Services Program (MSSP) benefit from the Coordinated Care Initiative (including managed long-term services and supports requiring Medi-Cal managed care plans and Cal MediConnect plans) in all seven counties of operation.
Additional details pertaining to this announcement can be found in this September 3, 2019 memo.
DHCS established five topic-specific stakeholder workgroups to further explore specific sections of the CalAIM proposal. Workgroups will meet between November 2019 and February 2020 as stated in this CalAIM Workgroup meeting schedule.
The workgroup application period closed on September 27, 2019 and DHCS notified applicants of their membership status on October 18th. Group size was limited to ensure a productive discussion environment, but the public is welcome to participate and provider feedback. Below is more information on the five CalAIM stakeholder workgroups.
Note: While most aspects of CalAIM will be discussed through workgroups, updates on those that are not will be included in the SAC, BH-SAC meetings, and other stakeholder venues.