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:

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 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

The draft CalAIM Section 1115 demonstration application and Section 1915(b) waiver overview are available for public review during the upcoming State public comment period starting April 6.

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

The 30-day public comment period for the CalAIM Section 1115 demonstration application and Section 1915(b) waiver overview will take place from Tuesday, April 6, 2021 through Thursday, May 6, 2021. To be assured consideration prior to submission to CMS, comments must be received no later than 11:59 PM (Pacific Time) Thursday, May 6, 2021. Please note that comments will continue to be accepted after May 6, 2021, but DHCS may not be able to consider those comments prior to the initial submission of the CalAIM waiver applications to CMS.

DHCS is inviting comments from stakeholders during two upcoming public hearing webinars, email, and/or mail.

• Public Hearings. DHCS will host the following public hearings to solicit stakeholder comments. The public hearings will be held electronically to promote social distancing and mitigate the spread of COVID-19. The meetings will have online video streaming and telephonic conference capabilities to ensure statewide accessibility.
• CalAIM Waiver Public Hearing Presentation

• Monday, April 26, 2021 – First Public Hearing

• 1:00 – 2:30 PM PT
• Register for Zoom conference link: https://manatt.zoom.us/webinar/register/WN_csWzNuSFQiiY46ZinTufLg
• Please register in advance to receive your unique login details and link to add the hearing to your calendar
• Call-in information (669) 900-6833 or (888) 788 0099 (Toll Free)
• Webinar ID: 944 4865 1547
• Passcode: 042621
• Callers do not need an email address to use the phone option and do not need to register in advance

• Monday, May 3, 2021 – Second Public Hearing

• 2:00 – 3:30 PM PT
• Register for Zoom conference: https://manatt.zoom.us/webinar/register/WN_dj9UAypdQ76aOtCXafuhSA
• Please register in advance to receive your unique login details and link to add the hearing to your calendar
• Call-in information (669) 900-6833 or (888) 788 0099 (Toll Free)
• Webinar ID: 994 3157 8945
• Passcode: 050321
• Callers do not need an email address to use the phone option and do not need to register in advance

• Email. You may send comments to CalAIMWaiver@dhcs.ca.gov; please indicate “CalAIM Section 1115 & 1915(b) Waivers" in the subject line of the email message.
• Mail-In. You may send written comments to the following address below; please indicate “CalAIM Section 1115 & 1915(b) Waivers" in the written message:

You may request a copy of the proposed CalAIM Section 1115 demonstration application; CalAIM Section 1915(b) waiver overview; and/or a copy of submitted public comments related to the CalAIM Section 1115 demonstration application and Section 1915(b) waiver overview by sending a written request to the mailing or email address listed above.

For individuals with disabilities, DHCS will provide assistive devices such as sign-language interpretation, real-time captioning, note takers, reading or writing assistance, and conversion of training or meeting materials into Braille, large print, audiocassette, or computer disk. To request such services or copies in an alternate format, please call or write:

Director's Office
P. O. Box 997413, MS 0000, Sacramento, CA 95899-7413
(916) 440-7400
Email: CalAIMWaiver@dhcs.ca.gov

Please note, the range of assistive services available may be limited if requests are received less than ten working days prior to the meeting or event.

After DHCS reviews comments submitted during this State public comment period, the CalAIM Section 1115 demonstration and Section 1915(b) waiver will be submitted to CMS. 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 officially 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 (https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81046). There is no federal public comment period for the 1915(b) waiver.

General Resources

• CalAIM homepage
• CalAIM Waiver Public Hearing Presentation
• 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.

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