​​​​​​​​​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:
  1. Identify and manage comprehensive needs through whole person care approaches and social drivers of health;
  2. Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility; and
  3. 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 relea​se​ 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. 

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

CalAIM Section 1115 and 1915(b) Amendments to Implement County-Based Model Changes in Medi-Cal Managed Care Program

On Friday, August 12th, the Department of Health Care Services (DHCS) commenced a 30 day public comment and Tribal public comment periods to solicit feedback on proposed amendments to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration and the Section 1915(b) waiver. DHCS is seeking the CalAIM Section 1115 and 1915(b) amendment approvals from the Centers for Medicare & Medicaid Services (CMS) to implement county-based model changes in the Medi-Cal Managed Care (MCMC) program. Through the Section 1915(b) waiver amendment, DHCS also plans to add or update language on policies or programs in the approved CalAIM 1915(b) waiver, including to reflect the MCMC model changes in select counties and direct contracts with the Kaiser Foundation Health Plan available for enrollment of certain Medi-Cal beneficiary populations in select counties. The following materials have been shared for public comment:
The 30-day public comment and Tribal public comment periods will be open from Friday, August 12, 2022 until Monday, September 12, 2022 no later than 11:59 PM PT (Pacific Time). Comments may be emailed to CalAIMWaiver@dhcs.ca.gov. Please indicate “CalAIM Section 1115 & 1915(b) Waiver Amendments” in the subject line of the email message. Register for the general public hearing on August 22, 2022. Register for the Tribal Public Hearing on August 31, 2022.​

Past Public Comme​​nt Opportunites

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.

Subscribe if you wish to be added to the DHCS stakeholder email service.​

Last modified date: 8/17/2022 10:27 AM