California received federal authority necessary to implement California Advancing and Innovating Medi-Cal (CalAIM), a framework that encompasses broad-based delivery system, program, and payment reform across the Medi-Cal program. CalAIM is an innovative and long-term commitment to transform and strengthen Medi-Cal, making the program more equitable, coordinated, and person-centered to help people maximize their health and life trajectory. CalAIM shifts Medi-Cal to a population health approach – first included in the Medi-Cal 2020 Section 1115 demonstration – to a statewide level that prioritizes prevention and addresses social drivers of health. Collectively, the CalAIM Section 1115 demonstration and CalAIM Section 1915(b) waiver, along with related contractual and Medi-Cal State Plan Amendments, will enable California to fully execute CalAIM initiatives, providing person-centered care to integrate care coordination across physical health, behavioral health, and local service providers.
Since 2018, DHCS has been working closely with stakeholders to design a transformation of key aspects of the Medi-Cal delivery system in order to accomplish three primary goals:
- Identify and manage comprehensive needs through whole person care approaches and social drivers of health;
- Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility; and
- Improve quality outcomes, reduce health disparities, and transform the delivery system through value‑based initiatives, modernization, and payment reform.
In 2019 and early 2020, DHCS conducted extensive stakeholder engagement for the proposed CalAIM initiatives. CalAIM implementation was scheduled to begin in January 2021, but was delayed due to the impact of the COVID-19 public health emergency. On December 29, 2020, DHCS received approval from the Centers for Medicare & Medicaid Services (CMS) for a 12-month extension (through December 31, 2021) of the existing Medi-Cal 2020 Section 1115 demonstration. DHCS submitted two requests in June 2021 to CMS: (1) the CalAIM Section 1115 demonstration (formerly entitled Medi-Cal 2020 Section 1115 demonstration) for a five-year renewal, with amendment; and (2) the CalAIM Section 1915(b) waiver for a five-year renewal, with amendment. DHCS received approval on December 29, 2021 for both the demonstration and waiver, effective through December 31, 2026. DHCS and CMS continue to work toward additional approvals for equity-oriented CalAIM initiatives in the state's Section 1115 demonstration requests – including services and supports for justice involved adults and youth, and reimbursement for traditional healers and natural helpers. CMS approval of these waivers is anticipated in early 2022 and materials will be updated accordingly.
See the CalAIM Waiver Issue Brief and December 29, 2021 press release for additional details.
Materials Approved by CMS
CMS approved the CalAIM Section 1115 demonstration and CalAIM Section 1915(b) waiver on December 29, 2021, both effective through December 31, 2026.
- CalAIM Section 1115 Demonstration
- CalAIM Section 1915(b) Waiver
Materials Submitted to CMS
DHCS submitted the following waiver applications to CMS on June 30, 2021, both five-year renewals and amendments to existing waivers:
State Public Comment Opportunities
DHCS hosted a 30-day public comment period from April 6 to May 6, 2021, for the draft CalAIM Section 1115 demonstration application and Section 1915(b) waiver overview. The following materials were shared for public comment:
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.
The public comments are split into five PDFs for ease of access, each containing a table of contents detailing the comments in the PDF. The public comments are redacted to remove protected health information, personal contact information, and signatures.
General Resources
Stakeholder Engagement
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.
