CalAIM 1115 Demonstration & 1915(b) Waiver
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California is requesting federal authority necessary to implement California Advancing & 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 whole-person care approach – first authorized by 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 needs, hard-to-reach populations, with the objective 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:
- Identify and manage member risk and need through whole-person care approaches and addressing social determinants of health;
- Move Medi-Cal to a more consistent and seamless system by increasing alignment across delivery systems, reducing complexity and increase flexibility; and
- 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 proposed CalAIM initiatives. CalAIM implementation was originally scheduled to begin in January 2021 but was delayed due the impact of the COVID-19 public health emergency. In light of this delay, 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 is currently preparing a request for a five-year renewal, with amendment, of the Medi-Cal 2020 Section 1115 demonstration, along with a comprehensive Section 1915(b) managed care waiver request that would also be for a five-year period. This webpage will be updated regularly as California seeks comments on and submits its CalAIM demonstration and waiver for federal approval. Pending negotiations with CMS, the CalAIM initiative is scheduled to begin implementation on January 1, 2022.
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
will review public comments submitted during the state’s 30-day public comment
period as part of its preparation in applying to CMS for the CalAIM Section
1115 demonstration and Section 1915(b) waiver in summer 2021. Upon submission
to CMS, a copy of the proposed CalAIM Section 1115 demonstration and Section
1915(b) waiver will be published on this webpage. Interested parties will also
have the opportunity to comment on the CalAIM Section 1115 demonstration during
the federal public comment period; the submitted application will be available
for comment on the CMS
website. There is no federal
public comment period for the 1915(b) waiver.
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.
