Home Providers & Partners CalAIM & Medi-Cal 2020 Demonstration Amendments

CalAIM & Medi-Cal 2020 Demonstration Amendments

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Please send any questions, comments, or concerns regarding 1115 demonstration amendments to CalAIMWaiver@dhcs.ca.gov.

CalAIM Amendments

Implement County-Based Model Changes in the Medi-Cal Managed Care Program

On Friday, November 4, 2022, the Department of Health Care Services (DHCS) submitted requests to amend the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration and Section 1915(b) waiver. DHCS is seeking the CalAIM Section 1115 and 1915(b) amendment approvals from the Centers for Medicare & Medicaid Services (CMS) to implement county-based plan model changes in the Medi-Cal Managed Care (MCMC) program. Through the Section 1915(b) waiver amendment, DHCS also plans to add or update language on policies or programs in the approved CalAIM 1915(b) waiver, including to reflect proposed direct contracts with the Kaiser Foundation Health Plan available for enrollment of certain Medi-Cal beneficiaries in select counties. DHCS hosted 30-day public comment and Tribal public comment periods to solicit feedback on the proposed amendments. Public comments were received by U.S. mail and email, as well as during a general public hearing and Tribal public webinar. DHCS submitted the following materials to CMS:

Increase and Eliminate Asset Limits

On June 29, 2022, the California Department of Health Care Services (DHCS) received approval from the Centers for Medicare and Medicaid Services (CMS) to amend the CalAIM Section 1115 demonstration to increase the asset limit and subsequently eliminate the asset test for certain populations. Along with amending the demonstration, CMS also issued technical corrections to the CalAIM demonstration Special Terms and Conditions (STCs). 

COVID-19 Response

Drug Medi-Cal Organized Delivery Systems and Community-Based Adult Services Modifications

On October 9, 2020, the Centers for Medicare & Medicaid Services (CMS) approved provisions to amend California’s Medi-Cal 2020 Section 1115(a) Demonstration to address the COVID-19 public health emergency. The approved provisions include modifications to the Drug Medi-Cal Organized Delivery Systems (DMC-ODS) program, and modifications to the Community-Based Adult Services (CBAS) program.

Drug Medi-Cal Organized Delivery Systems, Public Hospital Redesign and Incentives in Medi-Cal, and Global Payment Program Modifications

On July 27, 2020, the Centers for Medicare & Medicaid Services (CMS) approved provisions to amend California’s Medi-Cal 2020 Section 1115(a) Demonstration to address the COVID-19 public health emergency. The approved provisions include modifications to the Drug Medi-Cal Organized Delivery Systems (DMC-ODS) program, and modifications to the performance indicators for the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program and the Global Payment Program (GPP).

Medi-Cal 2020 Amendments

Global Payment Program and Program of All-Inclusive Care for the Elderly Amendment

This amendment allows DHCS to operate an additional six-month GPP program year (PY) for the service period of July 1, 2020, to December 31, 2020 (PY 6A). This amendment  also allows Medicaid beneficiaries in Orange County at their election to be disenrolled from CalOptima, a county-organized health system (COHS), to be enrolled in the Program of All-Inclusive Care for the Elderly (PACE), if eligible.

Health Homes Program – Freedom of Choice Amendment

This amendment provides a freedom of choice waiver to provide HHP services through Medi-Cal managed care delivery system to members enrolled in managed care. Fee-for-Service (FFS) members who meet HHP eligibility criteria may choose to enroll in a Medi-Cal Managed Care Plan (MCP) to receive HHP services as well as other state plan services that are provided through MCPs. HHP services will not be provided through a FFS delivery system.

Former Foster Care Youth Amendment

This amendment allows DHCS to provide coverage to former foster care youth under age 26, who were in foster care under the responsibility of a another state or tribe from any state when they “aged out” of foster care at age 18 and were enrolled in Medicaid at that time.

Whole Person Care – City Entity Technical Amendment

This technical amendment allows DHCS to accept applications from and designate a city to be a lead entity in the operation of a WPC pilot program within California.

Dental Transformation Initiative – Domain 1 Amendment

This amendment revises the methodology used by DHCS to determine the baseline metrics that will be used by new and existing dental service office locations for purposes of receiving incentive payments. In addition, the amendment authorizes DHCS to disburse partial incentive payments to provider service office locations that partially meet annual increases in the preventive services provided to children above the pre-determined baseline.

Whole Person Care – Tribal Entity Amendment

This amendment allows Federally Recognized Tribes and Tribal Health Programs to act in a lead entity role in the design, application, and operation of a WPC pilot program. The addition of these entities promotes the intent and goals of the WPC program in California.

Withdrawn Amendments

Medi-Cal Access Program Transition Amendment

This proposed amendment would allow DHCS to add the Medi-Cal Access Program (MCAP) population to the Medi-Cal Managed Care (MMC) delivery system. MCAP’s transition to the MMC delivery system will mirror the benefits of Medi-Cal full-scope pregnancy coverage, which includes dental services.