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. 

Txij li thaum Lub Kaum Ob Hlis 2021, CMS tau pom zoo rau qhov kev hloov kho rau CalAIM Tshooj 1115 qhov kev ua qauv qhia, suav nrog 1) kom tso cai rau lub xeev kom nce thiab thaum kawg tshem tawm cov kev txwv khoom vaj khoom tsev rau qee tus neeg muaj nyiaj tsawg uas tsis tau txiav txim siab siv cov txheej txheem nyiaj txiag raws li kev hloov kho cov nyiaj tau los tag nrho (MAGI); 2) kom tso cai rau lub xeev muab cov kev pabcuam rau cov pej xeem uas koom nrog kev ncaj ncees txog li 90 hnub ua ntej tso tawm; 3) los pab lub xeev muab kev saib xyuas zoo tshaj plaws rau nws cov tswv cuab raws li COVID-19 PHE, thiab xyuas kom meej tias kev rov ua dua tshiab ntawm kev tsim nyog thiab kev hloov pauv ntawm cov kev pab cuam kev pov hwm tshwm sim hauv cov txheej txheem kev txiav txim siab uas txo qis lub nra hnyav ntawm cov tswv cuab thiab txhawb kev txuas ntxiv ntawm kev pov hwm thaum kawg ntawm COVID-19 PHE; 4) los siv cov qauv hloov pauv hauv nroog hauv nws qhov kev pab cuam Medi-Cal Managed Care (ua raws li cov kev hloov pauv cuam tshuam tau pom zoo rau CalAIM Tshooj 1915 (b) kev zam); 5) los muab kev pab them nqi rau Medicaid thiab Children's Health Insurance Program (CHIP) cov neeg tau txais txiaj ntsig rau kev kho mob ib txwm muaj uas tau txais los ntawm Indian Health Service (IHS) cov chaw, cov chaw ua haujlwm los ntawm Tribes lossis Tribal cov koom haum raws li Indian Self-Determination and Education Assistance Act (ISDEAA), lossis cov chaw ua haujlwm los ntawm cov koom haum Indian hauv nroog raws li Title V ntawm Indian Health Care Improvement Act (IHCIA); thiab 6) los muab kev tso cai zam txim ntsig txog qhov kev pib ua qauv qhia rov qab tau pom zoo rau lub hom phiaj txwv, muab Title XXI kev siv nyiaj rau kev xav tau kev noj qab haus huv (HRSN), suav nrog kev hloov kho tshiab rau cov lus thiab tej yam kev mob tshwj xeeb (STCs) rau cov kev pabcuam HRSN uas tau pom zoo lawm raws li CMS lub sijhawm nyob thiab zaus txoj cai, thiab lwm yam kev hloov pauv kev txawj ntse. 

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

DHCS tau tuav lub sijhawm tawm tswv yim rau pej xeem 30 hnub txij lub Tsib Hlis 21, 2026 txog rau Lub Rau Hli 20, 2026 rau daim ntawv thov rov ua dua tshiab tsib xyoos ntawm California Advancing and Innovating Medi-Cal (CalAIM) Tshooj 1915 (b) waiver.

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

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.