​​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 (WPC), Health Homes Program (HHP), 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 and innovation 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. Between November 2019 and February 2020, DHCS conducted extensive stakeholder engagement for both CalAIM and the renewal of the federal authorities under which Medi-Cal operates (i.e. 1115 and 1915b waivers). 

DHCS postponed the planned implementation of the CalAIM initiative, originally scheduled for January 1, 2021 so that both DHCS and all of our partners could focus their limited resources on the needs arising from the public health emergency due to COVID-19.

DHCS released a revised CalAIM proposal on January 8, 2021.

• Revised CalAIM Proposal (1/8/2021)
• CalAIM Executive Summary and Key Changes

CalAIM Updates

The CalAIM proposal was updated on January 8, 2021. As implementation of various components of CalAIM begins, DHCS will provide updates here:

• CalAIM Relaunch Webinar:
• DHCS will hold a webinar to provide an overview of the 2021 CalAIM Proposal on Thursday, January 28, 2021 from 2:00-3:00 p.m. Please register for the webinar here. The webinar will review the components of the proposal including changes that were made to the original proposal based on stakeholder feedback. Attendees will be able to ask questions about the proposal as time allows. 
• Presentation Slides
• Enhanced Care Management and In Lieu of Services Technical Assistance
• DHCS will be providing technical assistance around the implementation of the enhanced care management benefit and optional in lieu of services throughout 2021. More information to come. Further, in February, DHCS intends to release several draft documents pertaining to Medi-Cal managed care plan (MCP) responsibilities related to the launch of the enhanced care management (ECM) benefit and in lieu of services (ILOS) program including the following:
  • Contract requirements for MCP administration and delivery of the ECM benefit and ILOS program;
  • Standard terms and conditions for MCP contracts with providers of ECM and ILOS; and,
  • A “Model of Care" template in which each MCP will describe how it plans to implement and administer ECM and ILOS. The Model of Care will include a section for MCPs to describe how they will transition existing WPC Pilots and HHP into ECM and ILOS, as applicable. 

  These documents will be released together first as draft for public comment and as final in spring 2021.

CalAIM Workgroups and Past Topic-Specific Stakeholder Meetings

In 2019, DHCS established topic-specific stakeholder workgroups to further explore specific sections of the CalAIM proposal. While these five workgroups concluded in February 2020, there are two workgroups currently underway: the Foster Care Model of Care workgroup and the Managed Long-Term Services and Supports and Duals Integration workgroup.

Foster Care Model of Care Workgroup: In consultation with key stakeholders, DHCS and the California Department of Social Services (CDSS) launched the Foster Care Model of Care workgroup in June 2020. More information on the workgroup can be found here. Please send any questions regarding the Foster Care Workgroup to CalAIMFoster@dhcs.ca.gov.

Managed Long-Term Services and Supports and Duals Integration Workgroup: In consultation with key stakeholders, and in coordination with the Governor’s Master Plan for Aging, DHCS is planning to launch the Managed Long-Term Services and Supports (MLTSS) and Duals Integration workgroup, which will have an initial meeting on February 4, 2021. The goal of the workgroup is to collaborate with stakeholders on the transition of Cal MediConnect (CMC) to a statewide MLTSS and Dual Eligible Special Needs Plan (D-SNP) aligned enrollment structure.  This policy is intended to help meet the statewide goals of improving care integration and person-centered care, under both CalAIM and the California Master Plan for Aging. More information on the workgroup can be found here. Please send any questions regarding this workgroup to info@calduals.org.

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.

Past Meetings:

• Mandatory Managed Care Enrollment Initiative
• February 27, 2020
• Meeting Presentation

• Transition of CMC and CCI to a statewide MLTSS and D-SNP structure
• February 24, 2020
• Meeting Materials

Stay Involved

Future updates will be presented for discussion during the SAC, BH-SAC, and other DHCS sponsored stakeholder meetings, as well as through the DHCS stakeholder email service. 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