Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Kev Qhia Txog CalAIM 1115 & Kev Tso Cai Xyoo 1915 (b)​​ 

CalAIM 1115 Demonstration & 1915(b) Waiver​​ 

Rov qab mus rau CalAIM Homepage​​ 

California tau txais tsoomfwv txoj cai tsim nyog los siv California Advancing and Innovating Medi-Cal (CalAIM), ib lub hauv paus uas suav nrog kev xa khoom dav dav, kev pab cuam, thiab kev hloov pauv kev them nyiaj thoob plaws Medi-Cal program. CalAIM yog ib qho kev cog lus tshiab thiab mus sij hawm ntev los hloov thiab ntxiv dag zog rau Medi-Cal, ua kom txoj haujlwm muaj kev sib luag, sib koom tes, thiab tib neeg lub hauv paus los pab tib neeg kom ua tiav lawv txoj kev noj qab haus huv thiab lub neej txoj hauv kev. CalAIM hloov Medi-Cal mus rau txoj hauv kev noj qab haus huv pej xeem - thawj zaug suav nrog hauv Medi-Cal 2020 Tshooj 1115 kev ua qauv qhia - mus rau theem thoob plaws xeev uas tseem ceeb rau kev tiv thaiv thiab hais txog kev noj qab haus huv cov neeg tsav tsheb. Sib sau ua ke, CalAIM Tshooj 1115 ua qauv qhia thiab CalAIM Tshooj 1915(b) zam, nrog rau cov ntawv cog lus ntsig txog thiab Medi-Cal Lub Xeev Txoj Kev Hloov Kho, yuav pab kom California ua tiav cov phiaj xwm CalAIM, muab kev saib xyuas tib neeg los koom ua ke kev saib xyuas thoob plaws lub cev, kev noj qab haus huv tus cwj pwm, thiab cov chaw muab kev pabcuam hauv zos.​​ 

Txij li xyoo 2018, DHCS tau ua haujlwm nrog cov neeg muaj feem cuam tshuam los tsim kev hloov pauv ntawm qhov tseem ceeb ntawm Medi-Cal kev xa khoom kom ua tiav peb lub hom phiaj tseem ceeb:​​ 

  • Txheeb xyuas thiab tswj xyuas cov kev xav tau los ntawm tag nrho cov kev saib xyuas tib neeg thiab cov neeg tsav tsheb kev noj qab haus huv;​​ 
  • Ua kom Medi-Cal ua kom muaj kev sib raug zoo thiab tsis sib haum xeeb rau cov neeg sau npe nkag los ntawm kev txo qis thiab ua kom yooj yim dua; thiab​​ 
  • Txhim kho cov txiaj ntsig tau zoo, txo qis kev noj qab haus huv tsis sib xws, thiab hloov pauv kev xa khoom los ntawm kev nqis tes ua tus nqi, kev hloov kho tshiab, thiab kev hloov pauv nyiaj txiag.​​ 

Hauv 2019 thiab thaum ntxov 2020, DHCS tau ua ntau yam kev koom tes rau cov neeg koom nrog rau cov phiaj xwm CalAIM. Kev siv CalAIM tau teem sijhawm pib thaum Lub Ib Hlis 2021, tab sis tau ncua sijhawm vim muaj kev cuam tshuam los ntawm COVID-19 kev noj qab haus huv rau pej xeem xwm txheej ceev. Thaum Lub Kaum Ob Hlis 29, 2020, DHCS tau txais kev pom zoo los ntawm Lub Chaw rau Medicare & Medicaid Services (CMS) rau 12 lub hlis txuas ntxiv (txog Lub Kaum Ob Hlis 31, 2021) ntawm Medi-Cal 2020 Tshooj 1115 uas twb muaj lawm. DHCS tau xa ob daim ntawv thov rau lub Rau Hli 2021 rau CMS: (1) CalAIM Tshooj 1115 ua qauv qhia (yav tas los muaj cai Medi-Cal 2020 Tshooj 1115 ua qauv qhia) rau tsib xyoos txuas ntxiv, nrog kev hloov kho; thiab (2) CalAIM Tshooj 1915(b) zam rau kev rov ua dua tsib xyoos, nrog kev hloov kho. DHCS tau txais kev pom zoo thaum Lub Kaum Ob Hlis 29, 2021 rau ob qho kev tawm tsam thiab kev zam, pib txij lub Kaum Ob Hlis 31, 2026.​​  

Since December 2021, CMS has approved six amendments to the CalAIM Section 1115 demonstration, including 1) to permit the state to increase and eventually eliminate asset limits for certain low-income individuals whose eligibility is not determined using the modified adjusted gross income (MAGI)-based financial methods; 2) to permit the state to provide in-reach services to justice-involved populations for up to 90-days prior to release; 3) to assist the state in delivering the most effective care to its members in light of the COVID-19 PHE, and ensure renewals of eligibility and transitions between coverage programs occur in an orderly process that minimizes member burden and promotes continuity of coverage at the end of the COVID-19 PHE; 4) to implement county-based model changes in its Medi-Cal Managed Care program (aligns with related changes approved in to the CalAIM Section 1915(b) waiver); 5) to provide coverage to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries for traditional health care practices received through Indian Health Service (IHS) facilities, facilities operated by Tribes or Tribal organizations under the Indian Self-Determination and Education Assistance Act (ISDEAA), or facilities operated by urban Indian organizations under Title V of the Indian Health Care Improvement Act (IHCIA); and 6) to provide waiver authority related to the approved reentry demonstration initiative for a limited purpose, provide Title XXI expenditure authority for health-related social needs (HRSN), include updates to the special terms and conditions (STCs) for already approved HRSN services in alignment with CMS’s housing duration and frequency policy, and other technical changes.​​  

DHCS and CMS continue to work toward additional approvals for equity-oriented CalAIM Section 1115 demonstration requests, including authority to provide continuous coverage in Medicaid (Medi-Cal) and the Children’s Health Insurance Program (CHIP) for eligible children through age four, regardless of when they first enroll in Medi-Cal or CHIP, and regardless of changes in circumstances that would otherwise cause a loss of eligibility.​​  

See the CalAIM Waiver Issue Brief and December 29, 2021 press release for additional details.​​  

Cov ntaub ntawv pom zoo los ntawm CMS​​ 

CMS tau pom zoo rau CalAIM Tshooj 1115 ua qauv qhia thiab CalAIM Tshooj 1915(b) zam rau lub Kaum Ob Hlis 29, 2021, ob qho tib si pib txij lub Kaum Ob Hlis 31, 2026.​​  

CalAIM Tshooj 1115 Kev Qhia​​ 

CalAIM Tshooj 1915(b) Kev zam​​ 

Cov ntaub ntawv xa mus rau CMS​​ 

DHCS tau xa cov hauv qab no mus rau CMS thaum lub Tsib Hlis 11, 2026​​ 

Daim Ntawv Thov Rov Ua Dua Tshiab ntawm CalAIM Tshooj 1115DHCS tau xa cov hauv qab no mus rau CMS thaum Lub Kaum Ib Hlis 25, 2024:​​ 

DHCS xa cov hauv qab no rau CMS thaum Lub Kaum Hli 20, 2023:​​  

DHCS tau xa cov lus thov hloov kho hauv qab no rau CMS thaum lub Kaum Ib Hlis 4 , 2022 :​​ 

DHCS tau xa cov ntawv thov zam hauv qab no rau CMS thaum Lub Rau Hli 30, 2021, ob qho tib si tsib xyoos txuas ntxiv thiab hloov kho rau cov kev zam uas twb muaj lawm:​​ 

DHCS tau xa Daim Ntawv Npaj Ua Haujlwm Hauv Xeev rau Kev Txhim Kho Kev Nkag Mus Rau Lub Kaum Hli 7th, 2022.​​  

Yav dhau los Public Comment Opportunities​​ 

Cov Kev Sib Tham Txog Kev Tawm Tswv Yim Rau Pej Xeem Tam Sim No​​  

DHCS yuav muaj lub sijhawm tawm tswv yim rau pej xeem 30 hnub txij hnub Thursday, Tsib Hlis 21 txog hnub Saturday, Rau Hli 20, 2026, los thov cov lus tawm tswv yim txog kev txuas ntxiv tsib xyoos ntawm California Advancing and Innovating Medi-Cal (CalAIM) Tshooj 1915(b) waiver, uas tam sim no yuav tas sij hawm rau lub Kaum Ob Hlis 31, 2026. Qhov kev rov ua dua tshiab no yog ua raws li cov kev siv zog yav dhau los los sib koom ua ke ntawm Medi-Cal cov txheej txheem kev saib xyuas kev noj qab haus huv hauv qab ib lub koom haum thiab qhia txog DHCS txoj kev cog lus txuas ntxiv mus rau kev txhim kho cov txiaj ntsig kev noj qab haus huv, txhawb nqa kev lav phib xaub, thiab kev txhim kho kev ncaj ncees thoob plaws hauv qhov kev pab cuam. Nws nrhiav kev txuas ntxiv cov tub ceev xwm uas twb muaj lawm thaum txhawb nqa kev siv zog los ua kom yooj yim rau kev noj qab haus huv ntawm tus cwj pwm los ntawm kev koom ua ke cov kev pabcuam kev noj qab haus huv ntawm lub hlwb thiab kev siv tshuaj yeeb dej cawv rau hauv ib qho kev xa khoom. Txhawm rau txhawb kev nkag siab ntawm cov neeg koom nrog, DHCS tau tshaj tawm cov ntsiab lus tseem ceeb ntawm daim ntawv thov rov ua dua tshiab CalAIM 1915 (b), piav qhia txog cov khoom tseem ceeb thiab cov cai tseem ceeb uas tswj hwm cov txheej txheem xa khoom uas tau tso cai raws li kev zam.​​  

Cov ntaub ntawv hauv qab no tau muab qhia rau pej xeem tawm tswv yim:​​  

Sau Cov Lus Qhia​​  

Cov lus sau tuaj yeem xa mus rau qhov chaw nyob hauv qab no; thov sau "CalAIM Section 1915(b) Waiver" hauv kab ntawv ntawm cov lus sau:​​  

Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv
Chaw Ua Haujlwm Tus Thawj Coj
Kev Ceeb Toom: Tyler Sadwith
PO Lub thawv xa ntawv 997413, MS 0000
Sacramento, California 95899-7413​​  

Cov lus tawm tswv yim kuj tseem tuaj yeem xa email rau CalAIMWaiver@dhcs.ca.gov. Thov sau "CalAIM Section 1915(b) Waiver" rau hauv kab ntawv ntawm cov lus email.​​  

Yuav kom paub tseeb tias tau txiav txim siab ua ntej xa daim ntawv thov CalAIM Seem 1915(b) Waiver Renewal Application mus rau lub Chaw Pabcuam Medicare & Medicaid hauv tebchaws, cov lus tawm tswv yim yuav tsum tau txais tsis pub dhau 11:59 PM (Pacific Time) rau lub Rau Hli 20, 2026.​​  

Daim Ntawv Thov Rov Ua Dua Tshiab ntawm CalAIM Tshooj 1115​​ 

DHCS tau tuav lub sijhawm tawm tswv yim rau pej xeem 30 hnub txij li Lub Ob Hlis 10 txog Lub Peb Hlis 12, 2026 rau qhov kev thov rov ua dua tsib xyoos ntawm California Advancing and Innovating Medi-Cal (CalAIM) Tshooj 1115 kev ua qauv qhia. Cov ntaub ntawv hauv qab no tau muab qhia rau pej xeem tawm tswv yim:​​   

DHCS tau txais 156 cov lus tawm tswv yim rau pej xeem, suav nrog 117 cov lus tawm tswv yim xa los ntawm email thiab 39 cov lus tawm tswv yim muab nyob rau lub sijhawm ob lub rooj sib hais rau pej xeem, ob lub rooj sib tham hauv web nrog cov neeg koom nrog Tribal thiab Indian Health Program, thiab ib lub rooj sib tham ntawm Pawg Neeg Saib Xyuas Kev Nyob Hauv Zej Zog ntawm Cov Neeg Xiam Oob Qhab thiab Cov Neeg Laus. DHCS tsis tau txais cov lus tawm tswv yim los ntawm pej xeem los ntawm kev xa ntawv. Cov CalAIM 1115 Renewal Public Hearing Slides tau nthuav tawm ntawm cov rooj sib tham rau pej xeem thiab cov ntaub ntawv webinar ntawm Tribal tuaj yeem pom ntawm nplooj ntawv web Indian Health Program Meetings, Webinars, thiab Presentations. Cov lus tawm tswv yim tau txais los ntawm email tuaj yeem nkag mus saib tau hauv daim ntawv CalAIM 1115 txuas ntxiv cov lus tawm tswv yim rau pej xeem no. Cov lus tawm tswv yim rau pej xeem raug tshem tawm kom tshem tawm cov ntaub ntawv kev noj qab haus huv uas raug tiv thaiv, cov ntaub ntawv tiv tauj tus kheej, thiab cov kos npe.​​  

CalAIM Kev Pabcuam Nruam rau Cov Menyuam Hloov Kho​​ 

DHCS tau tuav lub sijhawm 30-hnub kev tawm tswv yim rau pej xeem txij lub Ib Hlis 12 txog Lub Ob Hlis 12, 2024 txhawm rau thov kev tawm tswv yim txog kev hloov kho rau California Advancing and Innovating Medi-Cal (CalAIM) Tshooj 1115 ua qauv qhia ntsig txog kev pab them nqi tas mus li rau cov menyuam yaus. Cov ntaub ntawv hauv qab no tau muab qhia rau pej xeem tawm tswv yim:​​ 

CalAIM Kev Hloov Pauv Hloov Hloov Kev Rent​​ 

DHCS tau tuav lub sijhawm 30-hnub tawm tswv yim rau pej xeem txij lub Yim Hli 1 txog Lub Yim Hli 31, 2023 txhawm rau thov cov lus tawm tswv yim txog kev thov hloov kho rau California Advancing and Innovating Medi-Cal (CalAIM) Tshooj 1115 ua qauv qhia los muab cov kev pab cuam hloov pauv hloov pauv raws li Kev Pabcuam Zej Zog tshiab rau cov neeg muaj txiaj ntsig zoo hauv Medi-MCal Management system. Cov ntaub ntawv hauv qab no tau muab qhia rau pej xeem tawm tswv yim:​​ 

DHCS received 31 public comments, including 22 comments submitted via email, 8 comments provided live during two public hearings and a webinar with Tribal and Indian Health Program stakeholders, and 1 comment received by U.S. mail. Comments received via email and U.S. mail are accessible in this CalAIM rent public comment bundle document. The public comments are redacted to remove protected health information, personal contact information, and signatures.​​  

CalAIM Tshooj 1115 thiab 1915(b) Kev Hloov Kho Rau Kev Siv Lub Nroog-Raws Tus Qauv Hloov hauv Medi-Cal Managed Care Program​​ 

DHCS tau tuav lub sijhawm 30-hnub kev tawm tswv yim rau pej xeem txij lub Yim Hli 12 txog rau lub Cuaj Hlis 12, 2022, rau tsab ntawv CalAIM Tshooj 1115 thiab 1915(b) kev hloov kho los siv cov qauv hloov pauv hauv lub nroog hauv Medi-Cal Managed Care (MCMC). Cov ntaub ntawv hauv qab no tau muab qhia rau pej xeem tawm tswv yim:​​  

DHCS received 85 public comments during the CalAIM waiver amendment public comment period via email, U.S. mail, and orally or via the Zoom Q&A chat tool during public hearings. Comments received via email and/or U.S. mail are accessible in this public comment bundle document. The public documents are redacted to remove protected health information, personal contact information, and signatures.​​  

CalAIM Tshooj 1115 Kev Ua Yeeb Yam thiab 1915(b) Kev Tshaj Tawm Tshaj Tawm​​  

DHCS tau tuav lub sijhawm 30-hnub kev tawm tswv yim rau pej xeem txij lub Plaub Hlis 6 txog Lub Tsib Hlis 6, 2021, rau daim ntawv thov CalAIM Tshooj 1115 ua qauv qhia thiab Tshooj 1915(b) zam kev saib xyuas. Cov ntaub ntawv hauv qab no tau muab qhia rau pej xeem tawm tswv yim:​​ 

DHCS received approximately 271 public comments during the CalAIM waiver public comment period, including 169 comments submitted via email (CalAIMWaiver@dhcs.ca.gov) and/or US mail, as well as approximately 102 comments provided orally or via the Zoom Q&A chat tool during public hearings. Comments received via email and/or US mail are accessible using the below PDFs.​​ 

Cov lus tshaj tawm rau pej xeem tau muab faib ua tsib PDFs kom yooj yim nkag mus, txhua qhov muaj cov ntsiab lus piav qhia cov lus hauv PDF. Cov lus tshaj tawm pej xeem raug hloov kho kom tshem tawm cov ntaub ntawv tiv thaiv kev noj qab haus huv, cov ntaub ntawv tiv tauj tus kheej, thiab kos npe.​​  

Cov peev txheej dav dav​​ 

Stakeholder Engagement​​ 

On February 17, DHCS will conduct a briefing on the CalAIM Section 1115 demonstration and CalAIM Section 1915(b) waiver at the Stakeholder Advisory Committee (SAC) and Behavioral Health Stakeholder Advisory Committee (BH-SAC) meeting. This briefing will review the approved initiatives and components included in the CalAIM demonstration and waiver, provide an opportunity for the public to provide comment on both including the progress of the demonstration, and provide an update on pending CalAIM waiver requests​​ 

Please register in advance for the SAC and BH-SAC meeting. Written public comments may also be emailed to SACInquiries@dhcs.ca.gov by 5 p.m. February 18.​​  

DHCS values your input and will update this page shortly with information about CalAIM demonstration public comment opportunities. For more information about the CalAIM initiative and stakeholder engagement process, please visit the CalAIM homepage or contact CalAIMWaiver@dhcs.ca.gov.​​ 

Subscribe if you wish to be added to the DHCS stakeholder email service.​​