​California Advancing and Innovating Medi-Cal

Important Update on the COVID-19 Pandemic – Please Read Below

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 a better quality of life for Medi-Cal members as well as long-term cost savings/avoidance.

CalAIM has three primary goals:

1. Identify and manage member risk and need through whole person care approaches and addressing social determinants of health;
2. Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
3. Improve quality outcomes, reduce health disparities, 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). 

• CalAIM Proposal (10/29/2019)
• CalAIM Executive Summary
• CalAIM High-Level Summary

CalAIM and the COVID-19 Pandemic

DHCS is committed to ensuring that all of our partners are able to focus their limited resources on the needs arising from the public health emergency due to COVID-19. While the important goals and objectives we have outlined for CalAIM continue to be a high priority, DHCS is postponing CalAIM implementation timelines in order to allow all of us to effectively address COVID-19 in our communities.

DHCS plans to engage stakeholders and the federal government in both an extension of the existing 1115 waiver and the 1915b Special Mental Health waiver. In parallel, DHCS will continue to seek approval of our CalAIM proposals for a later date. We are committed to keeping you updated on the terms of this postponement and will release more details as they are finalized. DHCS and the entire Administration continue to be committed to advancing the CalAIM proposal. Thank you for your understanding.

CalAIM Updates

Regional Technical Assistance Meetings

The CalAIM Regional Meetings originally scheduled between April 16-May 4, 2020 have been postponed due to the COVID-19 public health emergency. More details will be posted when they become available.

Expanding Access to Integrated Care for Dual Eligible Californians Policy Memo

DHCS released “Expanding Access to Integrated Care for Dual Eligible Californians" policy memo, updated based on stakeholder feedback. This memo outlines the Department's transition plan for dual eligibles and CCI within the CalAIM initiative to improve the quality of life and health outcomes of the Medi-Cal population by implementing broad delivery system, program and payment reform across the program.

On February 24, 2020, DHCS discussed the proposal to transition Cal MediConnect (CMC) and CCI to a statewide Managed Long-Term Services and Supports (MLTSS) and Dual Eligible Special Needs Plan (D-SNP) structure. DHCS reviewed the updated policy as well as preview a new information sharing policy proposal for D-SNP plan year 2021 based on new federal guidance, engaged stakeholders around consumer messaging and protections, and invited questions and public comment. The meeting materials are available on this webpage.

Mandatory Managed Care Enrollment Initiative

DHCS hosted a webinar on February 27, 2020; the webinar was intended to provide an opportunity to discuss the Mandatory Managed Care Enrollment initiative, as part of the CalAIM proposal. (Please see page 59, and Appendix G, for information specific to Managed Care Enrollment within the proposal.)

• Meeting Presentation

CalAIM Workgroups

DHCS established five topic-specific stakeholder workgroups to further explore specific sections of the CalAIM proposal. With the exception of the Full Integration Plan and Foster Care Model of Care Workgroups, the workgroup process has now ended.

In consultation with key stakeholders, DHCS and the California Department of Social Services (CDSS) have jointly decided to launch the Foster Care Model of Care workgroup on June 26 instead of April 21. We want the workgroup to have the attention necessary to launch with full engagement. The DHCS and CDSS will be reviewing the applications submitted for membership in the workgroup and finalizing group membership by May 15, 2020. More information on the workgroup can be found here. Please send any questions regarding the Foster Care Workgroup to CalAIMFoster@dhcs.ca.gov.

The five workgroups listed below met from November 2019- February 2020:

• Population Health Management and Managed Care Plan Annual Enrollment;
• Enhanced Care Management and In Lieu of Services;
• Behavioral Health/ Behavioral Health Payment Reform;
• Full Integration Pilots; and
• NCQA Accreditation.

Stay Involved

The CalAIM workgroup process has now ended. Future updates will be presented for discussion during the SAC, BH-SAC, and other DHCS sponsored stakeholder meetings. 

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.

Resources                                       

• Medi-Cal Waivers Homepage
• 1115 Waiver Medi-Cal 2020 Demonstration Homepage
• 1915(b) Medi-Cal Specialty Mental Health Services Waiver Homepage

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