The Department of Health Care Services (DHCS) is innovating and transforming the Medi-Cal delivery system. CalAIM is moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care. Our goal is to extend supports and services beyond hospitals and health care settings directly into California communities.
Our vision is to meet people where they are in life, address social drivers of health, and break down the walls of health care. CalAIM will offer Medi-Cal enrollees coordinated and equitable access to services that address their physical, behavioral, developmental, dental, and long-term care needs, throughout their lives, from birth to a dignified end of life.
A Better Medi-Cal for Californians
CalAIM’s bold transformation aligns all elements of Medi-Cal into a system that is standardized, simplified, and focused on helping enrollees live healthier lives. Success requires the investment and sustained commitment of a broad network of health partners, including plans, providers, and community-based organizations, with incentives to achieve high quality of service. When CalAIM is fully implemented, Medi-Cal will better serve and benefit enrollees because it will be a seamless and streamlined health care system.
CalAIM seeks to transform health care for Californians through:
Population Health Management
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.
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Enhanced Care Management
Enhanced Care Management is person-centered care management provided to the highest-need Medi-Cal enrollees, primarily through in-person engagement where enrollees live, seek care, and choose to access services. Learn More >>
Community Supports (also known as “In Lieu of Services”)
Medi-Cal managed care plan partners will begin offering “Community Supports,” such as housing supports and medically tailored meals, which will play a fundamental role in meeting enrollees’ needs for heath and health-related services that address social drivers of health.
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New Dental Benefits
CalAIM will expand key dental benefits statewide, including a tool to identify risk factors of dental decay, and silver diamine fluoride for children and certain high-risk populations. Statewide pay-for-performance initiatives will reward dental providers for focusing on preventive services and continuity of care.
Behavioral Health Delivery System Transformation
DHCS will strengthen the state’s behavioral health continuum of care for all Californians and promote better integration with physical health care. CalAIM will streamline policies to improve access to behavioral health services, simplify how these services are funded, and support administrative integration of mental illness and substance use disorders treatment. Learn More >>
Services and Supports for Justice-Involved Adults and Youth
These initiatives help California address poor health outcomes and disproportionate risk of illness and accidental death among justice-involved Medi-Cal eligible adults and youth as they re-enter their communities. Learn More >>
Transition to Statewide Dual Eligible Special Needs Plans and Managed Long-Term Services and Supports
CalAIM will expand statewide a special kind of managed care plan that coordinates all Medicare and Medi-Cal benefits in one plan for enrollees who are eligible for both programs. CalAIM will also transition Medi-Cal to statewide managed long-term services and supports for dual eligible enrollees to better coordinate care, simplify administration and provide a more integrated experience.
Standard Enrollment with Consistent Managed Care Benefits
To improve each enrollee’s experience, CalAIM will expand the use of managed care plans and standardize benefits so that each enrollee will have access to a consistent set of services, no matter where they live.
Delivery System Transformation
CalAIM will explore other ways to improve care, including developing a long-term plan of action for foster youth; seeking a federal waiver for short-term residential treatment for enrollees with a Serious Mental Illness or Serious Emotional Disturbance; and, piloting full integration of physical health, behavioral health, and dental health in one managed care plan.
A Catalyst for Equity and Justice
A better Medi-Cal is a key building block of California’s broader commitment to building a healthier and more equitable state.
Black and Latino Californians have long faced health disparities that are the result of longstanding, structural racism in the health care system, housing, and employment. The pandemic exacerbated these inequities and underscored the need for CalAIM’s investment in Community Supports, and home and community-based services, including interventions that address social drivers of health. These lessons learned are at the heart of the CalAIM system transformation.
Peer support specialists and community health workers will advance California’s effort to promote health equity by providing culturally competent services.
CalAIM will support crucial transitions, including the path from
homelessness to housing, from incarceration to community re-entry, and from institutional to home-based care. It will extend Medi-Cal services to people who are incarcerated before their release from county jails, state prisons, and youth correctional facilities, and who are disproportionately people of color.