Current Initiatives

Learn About California Advancing and Innovating Medi-Cal (CalAIM)


Presentation

CalAIM - An Overview for Community-Based Organizations


Presentation

June 3, 2022 CalAIM | Funding Opportunities

Presentation Materials

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Program Updates

CalOptima, in collaboration with the Department of Health Care Services (DHCS) and Orange County Health Care Agency implemented CalAIM in Orange County on January 1, 2022. CalOptima is committed to keeping our stakeholders informed and providing opportunities for feedback. Please check back here for program updates.

Additional Community Supports

No sooner than July 1, 2022, CalOptima will make five additional Community Supports available to eligible members:

Short-Term Post-Hospitalization Housing

  • Provides members who do not have a residence and who have high medical or behavioral health needs to continue recovery immediately after exiting a facility

Day Habilitation Programs

  • Provides members with assistance in acquiring, retaining and improving the skills necessary to reside successfully at home and in their community

Personal Care and Homemaker Services

  • Provides members with assistance with Activities of Daily Living and Instrumental Activities of Daily Living

Medically Tailored Meals/Medically Supportive Food

  • Provides members with meals and nutrition services that help to achieve nutrition goals at critical times to help regain and maintain health

Sobering Centers

  • Provides members who are found to be publicly intoxicated with an alternative destination to an emergency department or jail

CalAIM Member Flyer

A new CalAIM member flyer is now available for use and distribution to inform members about the new CalAIM programs CalOptima is offering. 2022 CalAIM Member Flyer 

Enhanced Care Management (ECM) and Community Supports Referral Forms Available

Beginning January 1, 2022, providers, community-based organizations, members, authorized representatives and family members will be able to submit a referral form to a member’s assigned health network if they feel the member would benefit from ECM or Community Supports services. The referral forms are available in the Resources section of this page as well as the member and provider sections of CalOptima’s website.

About CalAIM

California Advancing and Innovating Medi-Cal (CalAIM) is a multiyear initiative, spanning from 2022 to 2027, by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of the Medi-Cal population by implementing broad delivery system, program and payment reforms across the Medi-Cal program.

The initiative leverages Medi-Cal as a tool to help address many of the complex challenges facing California’s most vulnerable residents, including individuals experiencing homelessness, children with complex medical conditions, justice-involved populations who have significant clinical needs and the growing aging population.

CalAIM has three primary goals:

  1. Identify and manage member risk and needs 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
  3. Improve quality outcomes, reduce health disparities and drive delivery system transformation and innovation through value-based initiatives, modernization of systems and payment reform

To better identify and manage member risk and needs for beneficiaries who may be challenged with medical and behavioral conditions, access to care , chronic illnesses and disabilities, DHCS is proposing a whole system, person-centered approach that will result in a better quality of life for our members as well as long-term cost savings and avoidance. Components of this system include:

  • A statewide population health management strategy
  • A statewide Enhanced Care Management (ECM) benefit
  • Implementation of optional Community Supports (formerly known as In Lieu of Services)
  • Implementation of incentive payments for plans and providers
  • Participation in the Serious Mental Illness (SMI)/Serious Emotional Disturbance (SED) demonstration
  • Required screening and enrollment for Medi-Cal prior to release from county jail
  • A pilot with full integration of physical health, behavioral health and oral health under one contracted entity in a county
  • A long-term plan for foster care children and youth

The major components of CalAIM build upon the success of previous federal waiver programs including, but not limited to, the Whole Person Care (WPC) pilot, Health Homes Program (HHP) and the Coordinated Care Initiative (CCI). Over the span of the initiative, services provided through WPC, HHP and CCI will be transitioned to CalAIM and made available to a larger portion of CalOptima’s membership.

CalOptima, in collaboration with the Orange County Health Care Agency and other community partners, is working diligently on a seamless transition for current HHP and WPC beneficiaries, who were among the first to receive CalAIM benefits on January 1, 2022. For more information on the components of CalAIM, please visit the DHCS CalAIM website.  

Past Updates

For previous CalAIM updates posted to this page, visit the Past Updates Archive    

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