CalAIM Long-Term Care Carve-In Transition
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Under CalAIM, institutional Long-Term Care (LTC) will be carved-in to Medi-Cal managed care in all counties in 2023, making coverage consistent across California.
Currently, the Medi-Cal LTC benefit is carved-in to Medi-Cal managed care in the following 22 County Organized Health System (COHS) and seven Coordinated Care Initiative (CCI) counties.
- Coordinated Care Initiative (CCI) Counties: Los Angeles, Orange, Riverside, San Bernardino, San Mateo, San Diego, and Santa Clara.
- County Organized Health Systems (COHS) Counties: Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, and Yolo.
- Note: Orange and San Mateo are COHS counties that are also CCI counties.
In the remaining 31 counties, institutional LTC coverage by MCPs is limited to the first month of admission and the following month. Members are disenrolled from the MCP to Medi-Cal fee-for-service after the second continuous month of admission in a SNF facility.
Under CalAIM, institutional LTC will be carved-in to Medi-Cal managed care in all remaining counties effective January 1, 2023. At that time, all MCPs will become responsible for the full LTC benefit at the following facility types and homes:
- Skilled Nursing Facility (SNF), including a distinct part or unit of a hospital;
Effective July 1, 2023, all MCPs will become responsible for the full LTC benefit at the following facility types and homes:
- Intermediate Care Facility (ICF)
- Intermediate Care Facility for Developmentally Disabled (ICF-DD);
- Subacute Facility;
- Pediatric Subacute Facility.
The goal of the Medi-Cal LTC carve-in is to better integrate care across institutional and home- and community-based settings as well as to make the LTC delivery system consistent across all counties in California. MCPs can offer complete care coordination, care management, and provide a broader array of services, including CalAIM Enhanced Care Management and Community Supports for Medi-Cal beneficiaries, than the traditional Medi-Cal FFS system.
There are no Key Documents at this time.
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Questions and Comments
Contact DHCS with any questions or comments about the CalAIM LTC Carve-In Transition at firstname.lastname@example.org.