Home Providers & Partners CalAIM 1115 Demonstration & 1915(b) Waiver

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:

  • 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. 

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 May 11, 2026

CalAIM Section 1115 Renewal ApplicationCalAIM Section 1115 Renewal ApplicationDHCS 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:

DHCS submitted the State Work Plan for Access Improvement on October 7th, 2022. 

Past Public Comment Opportunities

Current Public Comment Opportunities 

DHCS is hosting a 30-day public comment period from Thursday, May 21 through Saturday, June 20, 2026, to solicit feedback on the five-year renewal of the California Advancing and Innovating Medi-Cal (CalAIM) Section 1915(b) waiver, which is currently set to expire on December 31, 2026. The renewal builds on prior efforts to align Medi-Cal’s managed care delivery systems under a unified authority and reflects DHCS’ continued commitment to improving health outcomes, strengthening accountability, and advancing equity across the program. It seeks to continue existing authorities while advancing efforts to streamline behavioral health by integrating specialty mental health and substance use disorder services into a single delivery system. To support stakeholder understanding, DHCS posted a high-level summary of the CalAIM 1915(b) renewal application, outlining core components and key policies governing delivery systems authorized under the waiver. 

The following materials have been shared for public comment: 

Written Comments 

Written comments may be mailed to the following address; please indicate “CalAIM Section 1915(b) Waiver” in the subject line of the written message: 

Department of Health Care Services 
Director’s Office 
Attention: Tyler Sadwith 
P.O. Box 997413, MS 0000 
Sacramento, California 95899-7413 

Comments may also be emailed to CalAIMWaiver@dhcs.ca.gov. Please indicate “CalAIM Section 1915(b) Waiver” in the subject line of the email message. 

To ensure consideration prior to submission of the CalAIM Section 1915(b) Waiver Renewal Application to the federal Centers for Medicare & Medicaid Services, comments must be received no later than 11:59 PM (Pacific Time) on June 20, 2026. 

CalAIM Section 1115 Demonstration Renewal Application

DHCS hosted a 30-day public comment period from February 10 through March 12, 2026 on a five-year renewal request of the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration. The following materials were shared for public comment:  

DHCS received 156 public comments, including 117 comments submitted via email and 39 comments provided live during two public hearings, two webinars with Tribal and Indian Health Program stakeholders, and one meeting of the Disability and Aging Community Living Advisory Committee. DHCS did not receive any public comments via mail. The CalAIM 1115 Renewal Public Hearing Slides were presented at the public hearings and the Tribal webinar materials can be found on Indian Health Program Meetings, Webinars, and Presentations webpage. Comments received via email are accessible in this CalAIM 1115 renewal public comment bundle document. The public comments are redacted to remove protected health information, personal contact information, and signatures. 

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

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.

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