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

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.

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:

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:

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

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.

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:

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:

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.