​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:

  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 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

CalAIM Executive Summary

CalAIM High-Level Summary

Stay Involved

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 memo.  

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.

CalAIM Updates

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 memo​.

CalAIM Workgroups

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 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.

Pop. Health/Annual Enrollment                                         

This workgroup will provide input on the proposal to require Medi-Cal managed care plans to develop and maintain population health management strategies and provide input on the proposal to implement annu Medi-Cal health plan open enrollment.

Enhanced Care Management                          

This workgroup will provide input on the proposal to implement an enhanced care management benefit statewide and incorporate “in lieu of" services as part of the Medi-Cal managed care plan population health management strategies.

Behavioral Health                                              

This workgroup will provide input on the proposal to integrate county-level mental health and substance use disorder (SUD) programs under a single contract; proposed revisions to the medical necessity criteria for behavioral health services; and, the possibility of pursuing the mental health IMD waiver opportunity. A sub-workgroup will provide input on proposed changes to the reimbursement structure of county-level mental health and SUD services.

​Full Integration Plans                        

This workgroup will discuss the full integration of physical health, behavioral health, and oral health under one entity.

NCQA Accreditation                        

This workgroup will provide input on the proposal to require Medi-Cal managed care plans to obtain NCQA accreditation and feedback on the NCQA Medicaid module, the long-term services and supports distinction survey, and accreditation deeming policies.

 Resources                                       

Last modified date: 11/13/2019 3:14 PM