Impact Report
CalAIM Policy and Operational Guide
The Department of Health Care Services (DHCS) has released the CalAIM Policy and Operational Guide (also referred to as the “Guide") to memorialize policy design and operational requirements for implementing the Justice-Involved (JI) Reentry Initiative. This Guide intends to delineate for implementing stakeholders – correctional facilities (CFs), county behavioral health agencies, providers, community-based organizations (CBOs), County Social Services Departments (SSD) and Medi-Cal managed care plans (MCPs), among others – DHCS design and operational processes that will serve as the foundation for implementing this important initiative.
This Guide serves as the foundational framework for implementing the JI Reentry Initiative. In addition to this foundational document, the Guide contains additional standalone, supplemental chapters that provide in-depth policy and operational guidance on the Reentry Initiative. Additional supplemental chapters include:
Chapter 1: Enrolling Eligible Individuals in Medi-Cal (Coming soon...)
Chapter 2: Screening and Identification of Eligible Members (Coming soon...)
Chapter 3: Special Requirements for Incarcerated Youth (Coming soon...)
Chapter 4: Managed Care Plan Requirements (Coming soon...)
Chapter 5: Pre-Release Service Policy and Benefit Guidance (Coming soon...)
Chapter 6: Short-Term Model (Coming soon...)
Chapter 7: Medi-Cal Billing and Claims Requirements (Coming soon...)
Chapter 8: Considerations for Small and Rural Counties (Coming soon...)
Chapter 9: Data Sharing Requirements (Coming soon...)
Chapter 10: Program Monitoring (Coming soon...)
Readiness Assessment Documents
Guiding Documents, Communications and Resources
- Justice Involved Enhanced Care Management Standard Provider Terms and Conditions (February 2024)
- Policy and Operational Guide for Planning and Implementing the CalAIM Justice-Involved Reentry Initiative (October 20, 2023)
- Medicaid Section 1115 Demonstration Amendment Approval (January 26, 2023)
- Medicaid Section 1115 Demonstration Five-Year Renewal and Amendment Request: CalAIM Demonstration (June 30, 2021)
- CMS Approval Letter and Special Terms and Conditions (STCs) (December 29, 2021)
- 2022 All County Welfare Directors' Letters (ACWDL) and Medi-Cal Eligibility Division Information Letters (MEDIL)
- ACWDLs
- ACWDL 22-27 (November 10, 2022): CalAIM Mandatory Pre-Release Medi-Cal Application Process for Inmates and Youth of County Correctional Facility and County Youth Correctional Facilities
- ACWDL 22-26 (October 28, 2022): Implementation of Senate Bill (SB) 184 - Extension of the Suspension of Medi-Cal Benefits for Adult Inmates, Redetermination Requirements, and Suspension Timeline Guidelines
- MEDIL
- MEDIL I 22-46 (November 10, 2022): Pre-Release Medi-Cal Application Mandate Readiness Assessment Form for County Correctional Facilities/County Youth Correctional Facilities - Related to ACWDL 22-27
- MEDIL I 22-47 (November 10, 2022): Pre-Release Medi-Cal Application Mandate Readiness Assessment Form for County Welfare Departments - Related to ACWDL 22-27
- PAVE Enrollment for Correctional Facilities (this information is intended for government entities only)
- County Mental Health Information: Contact, Beneficiary Handbook, and Provider Directory
- CalAIM Enhanced Care Management Model of Care Template (September 2023)
Enhanced Care Management for the Individuals Transitioning from Incarceration Population of Focus
Individuals who are justice-involved may be eligible to receive Enhanced Care Management (ECM) under the Individuals Transitioning from Incarceration Population of Focus. Please visit the
ECM webpage and
Policy Guide for additional information.
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ECM is a new statewide Medi-Cal benefit available to select “Populations of Focus" that will address the needs of the highest-need members through intensive coordination of health and health-related services.
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It will meet members wherever they are—on the street, in a shelter, in their doctor's office, or at home—with the care they need, clinical or not.
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Members will have a single Lead Care Manager who will coordinate care and services across the physical, mental health and substance use disorder, dental, developmental, social services delivery systems, making it easier for them to get the right care at the right time.
