On December 29, 2021, the California Department of Health Care Services (DHCS) announced CMS’s approval of its California Advancing and Innovating Medi-Cal (CalAIM) proposal. CalAIM’s launch on January 1, 2022 is part of a commitment to make Medi-Cal more equitable, coordinated, and person-centered.

Medi-Cal is California’s Medicaid program which covers one in three Californians including more than half of school-age children, more than half of the state’s births, and more than two in three patient days in long-term care facilities. With federal approval of this proposal, CalAIM will shift Medi-Cal to a population health approach that prioritizes prevention and addresses social drivers of health. Key provisions of CalAIM’s approved initiatives include:

• Community Supports. This includes new statewide services covered by Medi-Cal managed care plans provided by local community providers as medically appropriate, cost-effective alternatives to traditional medical services or settings. Examples of Community Supports include assistance with housing supports, caregiver respite, food insecurity relief, and transitioning from nursing home care to the community. They are intended to both improve health and lower health care costs.

• Enhanced Care Management. This addresses clinical and non-clinical needs of the highest-need enrollees through intensive coordination of health and health-related services and meets enrollees primarily through in-person engagement where they live, seek care, and choose to access services.

• Delivery System Transition and Alignment. CalAIM shifts all of California’s managed care delivery systems – Medi-Cal Managed Care, Dental Managed Care, Specialty Mental Health Services, and Drug Medi-Cal Organized Delivery System – to one coordinating authority in order to simplify and align the state’s managed care programs, and enhance oversight and accountability of the managed care delivery systems as a whole.

• Providing Access and Transforming Health (PATH) Supports. CalAIM provides funding for community-based organizations, counties, and other local providers to expand capacity as some of the key CalAIM initiatives scale up across the state.

• Substance Use Disorder Services and Initiatives. CalAM authorizes several new initiatives that will advance treatment for individuals with substance use disorder, including contingency management, peer support specialists, and drug Medi-Cal organized delivery system services for short-term residents of institutions for mental disease.

• Supporting Coordination and Integration for Dual Eligibles. CalAIM coordinates Medi-Cal’s two distinct coverage programs to provide a more integrated experience for dual eligibles and makes available a statewide managed care plan that coordinates all Medicare and Medi-Cal benefits in one plan for enrollees who are eligible for both programs.

• New Dental Benefits. The proposal focuses on preventive services and continuity of care by expanding key dental benefits statewide including a statewide expansion of a Caries Risk Assessment bundle for all Medi-Cal children, silver diamine fluoride for children and high-risk adult populations, and pay-for-performance initiatives for dental providers.

• Chiropractic Services for Indian Health Service and Tribal Facilities. CalAIM provides authority to continue to pay for chiropractic services provided by Tribal providers that were eliminated as a Medi-Cal covered benefit in 2009.

• Global Payment Program. It renews the Global Payment Program to provide a statewide pool of funding for care provided to California’s remaining uninsured population in an effort to streamline funding sources for the state’s uninsured population served by public hospitals, with a renewed focus on addressing social needs and responding to the impacts of systemic racism and inequities.

In addition to the above initiatives, two additional components of CalAIM that are still being negotiated include: (i) services and supports for justice-involved adults and youth, which will focus on stabilizing health pre-release, ensuring continuity of coverage through Medi-Cal pre-release enrollment strategies, and supporting re-entry to the community, and (ii) approval for reimbursements for services provided by Traditional Healers and Natural Helpers.

More information about CalAIM from California DHCS can be found here.