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.


May General Stakeholder Event

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 meeting materials from this event, please click on the link below.

May 14, 2021 General Stakeholder Meeting Materials 

CalAIM Frequently Asked Questions (FAQ) 

CalOptima CalAIM Proposal

CalOptima’s CalAIM proposed implementation Model of Care (MOC) for Enhanced Care Management (ECM) and In Lieu of Services (ILOS) will build upon the Health Home Program (HHP) and Whole-Person Care (WPC) Pilot infrastructures by preserving existing member relationships with HHP and WPC service providers. Beginning January 1, 2022, these providers will deliver ECM services and ILOS 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:

  • Delegate ECM services to its health networks who will continue to provide care management to their members
  • For more information on ECM, please see the CalOptima ECM Fact Sheet 
  • Contract directly with existing HHP and WPC providers to provide ILOS and maintain financial responsibility for these services
  • CalOptima will provide the following ILOS to eligible CalOptima members, beginning January 1, 2022:
    • Housing transition/navigation services
    • Housing tenancy and sustainability services
    • Housing deposits
    • Recuperative care (medical respite)
  • For more information on the above ILOS, please see the CalOptima ILOS Fact Sheet 

Not only will CalOptima work closely with its ECM and ILOS service providers, but also with members’ primary care providers, specialists, community-based entities, and other service providers to identify and engage eligible members where they live, seek care or are accessible and may benefit from receiving such services.

CalOptima is seeking your input to identify the next phase of ILOS for potential implementation (no sooner than July 1, 2022, subject to CalOptima Board and DHCS approval) from the list below:

  • Asthma Remediation
  • Community Transition Services/Nursing Facility Transition to a Home
  • Day Habilitation Programs
  • Environmental Accessibility Adaptations (Home Modifications)
  • Meals/Medically Tailored Meals
  • Nursing Facility Transition/Diversion to Assisted Living Facilities
  • Personal Care and Homemaker Service
  • Respite Services
  • Short-Term Post-Hospitalization Housing
  • Sobering Centers

Please complete the survey by June 4, 2021 by clicking here.  

DHCS Proposal

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 multi-year initiative, spanning from 2022 to 2027, by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of our population by implementing broad delivery system, as well as program and payment reform 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 such as individuals experiencing homelessness, behavioral health care access, complex medical care for children, the growing number of 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 In Lieu of Services (ILOS)
  • 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
  • Pilot 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, Whole Person Care (WPC), Health Homes Program (HHP) and the Coordinated Care Initiative (CCI). Over the span of the initiative, services provided under programs such as WPC, HHP and CCI will be transitioned under 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 such as ECM and ILOS starting January 1, 2022. For more information on the components of CalAIM, please visit the DHCS CalAIM website.  

About Us
How To...
Careers
Latest News