​CalAIM 1115 Demonstration & 1915(b) Waiver

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California is requesting 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 recognizes the opportunity to move California's whol​e-person care approach – first included in the Medi-Cal 2020 Section 1115 demonstration – to a statewide level, with a clear focus on improving health and reducing health disparities and inequities. Collectively, the Section 1115 CalAIM demonstration and Section 1915(b) waiver, along with related contractual and Medi-Cal State Plan changes, will enable California to fully execute the CalAIM initiative, providing benefits to certain high-need, hard-to-reach populations, with the goal of improving health outcomes for Medi-Cal beneficiaries and other low-income people in the state. 

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:

1. Identify and manage member risk and need through whole-person care approaches and addressing social determinants of health;
2. Move Medi-Cal to a more consistent and seamless system by increasing alignment across delivery systems, reducing complexity and increase flexibility; and
3. Improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, 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 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 is requesting approval by December 2021 to enable implementation in January 2022.

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:

• CalAIM Section 1115 demonstration application and cover letter
• CMS Completeness Letter
• CalAIM Section 1915(b) waiver application
• Cover letter
• Attachments
• Appendix: Cost Effectiveness BH SMHS & DMC-ODS
• Appendix: Cost Effectiveness MCMC & Dental MC

Interested parties have the opportunity to comment on the CalAIM Section 1115 demonstration during the federal public comment period, with more information available on the CMS website. There is no federal public comment period for the CalAIM Section 1915(b) waiver.

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:

• Proposed CalAIM Section 1115 demonstration amendment and renewal application
• Proposed Section 1915(b) waiver overview
• Public notice
• Abbreviated public notice

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. 

• Public Comment Bundle #1
• Public Comment Bundle #2
• Public Comment Bundle #3
• Public Comment Bundle #4
• Public Comment Bundle #5

General Resources

• CalAIM homepage
• CalAIM Waiver Public Hearing Presentation
• May 3rd CalAIM Waiver Public Hearing Comments (impacted by technical issues)
• Current Medi-Cal 2020 Section 1115 Demonstration on Medicaid.gov (external link to CMS' website)
• Medi-Cal 2020 Section 1115 demonstration 12-month extension webpage
• Medi-Cal 2020 Section 1115 demonstration webpage
• SMHS Section 1915(b) waiver webpage
• DHCS Indian Health Program webpage

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.

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