CalAIM 1115 Demonstration & 1915(b) Waiver
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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:
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Identify and manage comprehensive needs through whole person care approaches and social drivers of health;
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Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility; and
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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.
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.
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 to CMS on November 25, 2024:
DHCS submitted the following to CMS on October 20, 2023:
DHCS submitted the following amendment requests to CMS on November 4, 2022:
DHCS submitted the following waiver applications to CMS on June 30, 2021, both five-year renewals and amendments to existing waivers:
Past Public Comment Opportunities
CalAIM Section 1115 and 1915(b) Applications
CalAIM Continuous Coverage for Children Amendment
DHCS hosted a 30-day public comment period from January 12 to February 12, 2024 to solicit feedback on a proposed amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration related to continuous coverage for children. The following materials have been shared for public comment:
CalAIM Transitional Rent Services Amendment
DHCS hosted a 30-day public comment period from August 1 to August 31, 2023 to solicit feedback on a proposed amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration to provide transitional rent services as a new Community Support for quality individuals in the Medi-Cal Managed Care (MCMC) delivery system. The following materials were shared for public comment:
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 Section 1115 and 1915(b) Amendments to Implement County-Based Model Changes in Medi-Cal Managed Care Program
DHCS hosted a 30-day public comment period from August 12 to September 12, 2022, for the draft CalAIM Section 1115 and 1915(b) amendments to implement county-based model changes in the Medi-Cal Managed Care (MCMC) program. The following materials were shared for public comment:
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 Section 1115 Demonstration and 1915(b) Waiver Overview
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.
