Current Initiatives

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

Program Updates

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

Stakeholder Meeting Held in September

On September 22, 2021, CalOptima hosted a community stakeholder event for impacted community providers, health networks and the County to discuss operational processes, including referral pathways, eligibility and system requirements. CalOptima is using the feedback provided at this event to further inform its Enhanced Care Management (ECM) and Community Supports implementation.

In Lieu of Services Benefit Renamed Community Supports

In September 2021, DHCS announced a transition from the CalAIM term of In Lieu of Services (ILOS) to Community Supports. No change in services or the implementation timeline will occur.

Member Notices Planned

CalOptima will inform members about the new ECM benefit as well as the transition from the Health Homes Program (HHP) and the Whole Person Care (WPC) pilot to ECM and Community Supports.

All CalOptima members will receive a notice describing the new ECM benefit by December 1, 2021.

All CalOptima members enrolled in HHP or WPC will receive a notice explaining the transition of services to ECM and Community Supports by December 1, 2021.

ECM and Community Supports Provider Readiness Underway

CalOptima’s readiness assessment period for ECM and Community Supports providers will occur from September through December 2021. The readiness assessment will ensure that providers have the capacity to start providing the required ECM and Community Supports services to eligible members on January 1, 2022.

CalOptima’s CalAIM Model of Care (MOC) Submitted

On October 1, 2021, CalOptima submitted the final portion of its MOC proposal to DHCS for approval. The full MOC consisted of policies and procedures, contract templates, and provider capacity information.

CalOptima’s MOC for ECM and Community Supports builds upon the HHP and WPC pilot infrastructures by preserving existing member relationships. Beginning January 1, 2022, these providers will deliver ECM services and Community Supports to eligible CalOptima members.

CalOptima’s MOC supports and enhances its well-established provider network and maintains current, and often long-standing, community partners’ relationships with their CalOptima members. CalOptima will achieve this by:

  • Delegating ECM services to health networks who will continue to provide care management to their members
  • Contracting directly with existing HHP and WPC providers to provide Community Supports and maintaining financial responsibility for these services
  • Providing the following Community Supports to eligible CalOptima members, beginning January 1, 2022:
    • Housing transition navigation services
    • Housing tenancy and sustaining services
    • Housing deposits
    • Recuperative care (medical respite)

Not only will CalOptima work closely with its ECM and Community Supports providers, but also with members’ primary care providers, specialists, community-based entities, and other service providers to identify and engage eligible members who may benefit from receiving such services.

May General Stakeholder Event Held

CalOptima hosted a virtual stakeholder event on May 14, 2021. During the event, CalOptima provided an overview of CalAIM, discussed target populations and outreach, and conducted a question and answer session. To view FAQs from this event, please click on the link below.

CalAIM Frequently Asked Questions (FAQ) 

DHCS Proposal Postponed to 2022

DHCS postponed the planned implementation of the CalAIM initiative, originally scheduled for January 1, 2021, so that both DHCS and all its 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, with a scheduled implementation date of January 1, 2022.

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 need 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 need for beneficiaries who may be challenged with medical and behavioral conditions, access to care as well as 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 will be 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.  

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