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
CalAIM has 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 reducing complexity and increasing 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.
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.
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 from 2:00-3:00 p.m. The webinar reviewed the components
of the proposal including changes that were made to the original proposal based
on stakeholder feedback.
- Presentation Slides
- ECM and ILOS Coding Guidance: a defined set of HCPCS codes and modifiers that must be used for encounter reporting by MCPs for all ECM and ILOS services.
DHCS held an ECM & ILOS Relaunch webinar on February 25,
2021 from 2:00 – 3:00 PM PT. The webinar reviewed the draft ECM
and ILOS documents, with a focus on major updates, and covered other
important aspects of the ECM and ILOS initiatives, including: timelines for
implementation, the process the Managed Care Plans (MCPs) will be expected to
follow to implement ECM and ILOS, and upcoming technical assistance and
implementation engagement activities.
The public comment period for the ECM & ILOS draft documents
ends on March 12, 2021. All comments should be submitted to DHCS by email at
the following address: CalAIMECMILOS@dhcs.ca.gov. DHCS will
review stakeholder feedback and finalize in early April.
CalAIM Waiver Public Comment
The draft CalAIM Section 1115 demonstration application and Section 1915(b) waiver overview are available for public review starting April 6:
The 30-day public comment period for the CalAIM Section 1115 demonstration application is 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. For more details on how to submit public comments, visit CalAIM 1115 Demonstration & 1915(b) Waiver.
CalAIM Workgroups and Past Topic-Specific Stakeholder Meetings
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
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
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.
information on the workgroup can be found here. Please send any questions
regarding this workgroup to email@example.com.
The five workgroups listed below met from November 2019 - February 2020:
- Mandatory Managed Care Enrollment Initiative
- Transition of CMC and CCI to a statewide MLTSS and D-SNP structure
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