The California Department of Health Care Services (DHCS) launched California Advancing and Innovating Medi-Cal (CalAIM) in January 2022. This initiative intends to improve outcomes for Medi-Cal enrollees, who often have complex health and social needs.
Individuals with needs such as mental health conditions, hunger, and homelessness often lack help because different providers and social services within the Medi-Cal system are unintegrated. Providers may not coordinate with each other, which can lead to more negative health outcomes.
CalAIM is an effort to standardize care across the state. The initiative pairs clinical and non-medical services, focus on population health and whole-person care, emphasize value-based care, and better coordinate those services provided by counties and community-based organizations.
What has CalAIM done so far?
Since launching in January 2022, several huge changes have taken place across California as part of CalAIM. Tens of thousands of Medi-Cal enrollees who were supported by CalAIM’s precursors have transitioned to Medi-Cal.
DHCS launched Enhanced Care Management (ECM) in response to the upcoming end to the Covid-19 Public Health Emergency, and the potential loss of coverage for many Medi-Cal beneficiaries. ECM aims to promote continuity of coverage. ECM particularly supports enrollees with complex needs that often use multiple care systems, such as primary and specialty care, mental health, and substance use disorder (SUD).
Medi-Cal now offers Community Supports, statewide services provided through managed care plans to address social determinants of health. The plans offer up to 14 non-traditional services, such as connecting people to housing or asthma remediation.
CalAIM has a “No Wrong Door” policy, which helps Medi-Cal patients receive mental healthcare regardless of where they go first. Providers will also be reimbursed for that mental healthcare. Medi-Cal Managed Care Plans and County Mental Health Plans are jointly responsible for implementing this policy.
Screening and Transition of Care Tools have been implemented across the state. These are intended to streamline and standardize the process by which Medi-Cal enrollees are referred to mental health plan networks versus managed care networks.
Federal officials approved a Medi-Cal expansion request to allow California inmates to access Medi-Cal services. Under this expansion, incarcerated individuals with health issues, including mental illness and SUD, are eligible for assessment and treatment up to 90 days before release.
Plans for CalAIM in 2023 and Beyond
CalAIM will continue to increase engagement between providers and Medi-Cal members and improve health outcomes. Many of these changes involve behavioral health and include:
- Starting in 2023, managed care plans must implement the Population Health Management program. This aims to provide more proactive care, identifying health conditions before they become crises.
- Starting July 1, 2023, the CalAIM Behavioral Health Payment Reform initiative will change how county behavioral health plans claim federal reimbursement. This includes a move to more value-based payments. (Download this PDF for an overview of the changes.)
- DHCS will apply for a new Medicaid Section 1115 Demonstration to improve mental health services for Medi-Cal enrollees.
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