​​​​​​​​​​​​​​​​​​​​​​​California Advancing and Innovating Medi-Cal

CalAIM is a multi-year initiative by DHCS to improve the quality of life and health outcomes of our population by implementing broad delivery system, program and payment reform across the Medi-Cal program. The major components of CalAIM build upon the successful outcomes of various pilots (including but not limited to the Whole Person Care Pilots (WPC), Health Homes Program (HHP), and the Coordinated Care Initiative) from the previous federal waivers and will result in a better quality of life for Medi-Cal members as well as long-term cost savings/avoidance.

CalAIM has 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 reducing complexity and increasing 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.

DHCS formally released the CalAIM proposal on October 29, 2019, at the Stakeholder Advisory Committee (SAC) and Behavioral Health Stakeholder Advisory Committee (BH-SAC) meetings. Between November 2019 and February 2020, DHCS conducted extensive stakeholder engagement for both CalAIM and the renewal of the federal authorities under which Medi-Cal operates (i.e. 1115 and 1915b waivers). 

DHCS postponed the planned implementation of the CalAIM initiative, originally scheduled for January 1, 2021 so that both DHCS and all of our partners could focus their limited resources on the needs arising from the public health emergency due to COVID-19.

DHCS released a revised CalAIM proposal on January 8, 2021.

• Revised CalAIM Proposal
• CalAIM Executive Summary and Key Changes

CalAIM Updates​​

The CalAIM proposal was updated on January 8, 2021. As implementation of various components of CalAIM begins, DHCS will provide updates here:

• CalAIM Relaunch Webinar:
• DHCS held a webinar to provide an overview of the 2021 CalAIM Proposal on Thursday, January 28, 2021. The webinar reviewed the components of the proposal including changes made to the original proposal based on stakeholder feedback. 
• Presentation Slides
• CalAIM 1115 Demonstration & 1915(b) Waiver:
  
• DHCS submitted the CalAIM Section 1115 demonstration application and CalAIM Section 1915(b) waiver application to the Centers for Medicare & Medicaid Services (CMS). For additional details, visit the CalAIM 1115 Demonstration & 1915(b) Waiver webpage or the CMS website.
• Enhanced Care Management (ECM) and In Lieu of Services (ILOS) are foundational components of CalAIM. 

IMPORTANT UPDATE: ​​The California Department of Health Care Services (DHCS) is accepting written feedback on the Incentive Payment Draft Program Design and Measure Set, please submit feedback to CalAIMECMILOS@dhcs.ca.gov by Wednesday, July 14. ​

DHCS has released finalized requirements documents and additional supporting resources for ECM and ILOS, which are available below. ​​​

​Please note that DHCS will incorporate the provisions in the DHCS-MCP ECM and ILOS Contract Template​ below as an attachment to existing MCP Contracts.​ These provisions will also be included as part of the 2024 Request for Proposal (RFP)/Main Contract​. 

1. ​Incentive Payment Draft Measure Set​​ ​(New in June)​
• ​​​CalAIM EC​M and ILOS Performance Incentive Payments Webinar​​​
  
2. Finalized DHCS-MCP ECM and ILOS Contract Template: Standardized statewide requirements regarding the administration and delivery of ECM and ILOS that will be appended to DHCS-MCP model contracts. Please note that DHCS will incorporate these provisions as an attachment to existing MCP Contracts. These provisions will also be included as part of the 2024 Request for Proposal (RFP)/Main Contract. ​
   
3. ​Finalized ECM and ILOS Standard Provider Terms and Conditions​: ​Standardized contract requirements that MCPs will be required to include in contracts with ECM and ILOS Providers.
   
4. ​​Finalized ECM and ILOS Model of Care Template​: ​In which each MCP will describe how it plans to design, implement, and administer ECM and ILOS.
   
5. ​​Finalized ECM Key Design Implementation Decisions​:​ Summarizes final ECM design and implementation decisions related to three key implementation areas: ECM and ILOS Implementation Timeline, ECM Populations of Focus definitions, and ECM Overlap with other Programs & Exclusions.
   
6. ECM and ILOS Change Memo: Summarizes public comments and key policy changes DHCS made to ECM requirements documents based on stakeholder feedback. 
   
7. Model of Care Cover Note:​ Provides additional information regarding MOC requirements and submission and approval process.
   
8. Updated ECM and ILOS Frequently Asked Questions (FAQs):​ Provides additional guidance and clarifications regarding ECM and ILOS policies and operational procedures.
   
9. Providing Access and Transforming Health (PATH) Supports FAQs​:​ Provides general information about PATH, funding uses, and how PATH relates to CalAIM and the Governor's budget.
   

CalAIM Workgroups and Past Topic-Specific Stakeholder Meetings

In 2019, DHCS established topic-specific stakeholder workgroups to further explore specific sections of the CalAIM proposal. While these five workgroups concluded in February 2020, there are two workgroups currently underway: the Foster Care Model of Care workgroup and the Managed Long-Term Services and Supports and Duals Integration workgroup.

Foster Care Model of Care Workgroup: In consultation with key stakeholders, DHCS and the California Department of Social Services (CDSS) launched the Foster Care Model of Care workgroup in June 2020. More information on the workgroup can be found here. Please send any questions regarding the Foster Care Workgroup to CalAIMFoster@dhcs.ca.gov.

Managed Long-Term Services and Supports and Duals Integration Workgroup: In consultation with key stakeholders, and in coordination with the Governor’s Master Plan for Aging, DHCS is planning to launch the Managed Long-Term Services and Supports (MLTSS) and Duals Integration workgroup, which will have an initial meeting on February 4, 2021. The goal of the workgroup is to collaborate with stakeholders on the transition of Cal MediConnect (CMC) to a statewide MLTSS and Dual Eligible Special Needs Plan (D-SNP) aligned enrollment structure.  This policy is intended to help meet the statewide goals of improving care integration and person-centered care, under both CalAIM and the California Master Plan for Aging. More information on the workgroup can be ​found here. Please send any questions regarding this workgroup to info@calduals.org.

The five workgroups listed below met from November 2019 - February 2020:

• Population Health Management and Managed Care Plan Annual Enrollment;
• Enhanced Care Management and In Lieu of Services;
• Behavioral Health/Behavioral Health Payment Reform;
• Full Integration Pilots; and
• NCQA Accreditation.

Past Meetings:

• Mandatory Managed Care Enrollment Initiative
• February 27, 2020
• Meeting Presentation

• Transition of CMC and CCI to a statewide MLTSS and D-SNP structure
• February 24, 2020
• Meeting Materials

Stay Involved

Future updates will be presented for discussion during the SAC, BH-SAC, and other DHCS sponsored stakeholder meetings, as well as through the DHCS stakeholder email service. Please subscribe to DHCS' stakeholder email service to receive CalAIM updates and information about upcoming stakeholder meetings. For other comments, questions, or concerns, please contact CalAIM@dhcs.ca.gov.

Resources                                       

• CalAIM 1115 and 1915(b) Waiver Renewals     
• Medi-Cal Waivers Homepage
• 1115 Waiver Medi-Cal 2020 Demonstration Homepage
• 1915(b) Medi-Cal Specialty Mental Health Services Waiver Homepage
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