Identify and manage member risk and needs through whole-person care approaches and address social determinants of health
Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility
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 the risk and needs of members who may be challenged with medical and behavioral conditions, lack of access to care or chronic illnesses and disabilities, CalAIM is a whole-system, person-centered approach that will result in a better quality of life for members, as well as long-term cost savings and avoidance. Components of this system include:
Helps members establish a basic household with funding for one-time costs, like a security deposit, setup fees/deposits for utilities, one-time cleaning, furniture and/or other goods.
Provides members who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical/ psychiatric/substance use disorder recovery immediately after exiting an inpatient hospital, residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care.
Provides members with MTMs or groceries to address memebers' chronic or other serious conditions that are nutrition sensitive.
Allows members to live in the community and avoid further institutionalization.
Enhanced Care Management (ECM) is a new statewide Medi-Cal benefit available to select populations of focus that addresses the clinical and non-clinical needs of the highest-utilizing members through intensive coordination of health and health-related services. ECM meets members wherever they are — on the street, in a shelter, in their doctor’s office or at home. Members have a single lead care manager who will coordinate care and services among the physical, behavioral, dental, developmental and social services delivery systems, making it easier for them to get the right care at the right time.
Populations of focus:
Explore CalOptima Health’s tailored resources to support CalAIM implementation. Access shareable multilingual flyers, brochures and clinical tip sheets designed to help providers deliver whole-person care and connect members to critical services.
Notice of Interest Opportunity for Street Medicine Expansion
Housing and Homelessness Incentive Program (HHIP)
To address health disparities and social determinants of health, CalOptima Health earned incentive funds from the Department of Health Care Services for making investments and progress in addressing homelessness and keeping people housed. Those funds were coupled with Board-approved dollars, and grants were awarded through a competitive application process.
Incentive Payment Program (IPP)
The CalAIM Incentive Payment Program supports the implementation and expansion of Enhanced Care Management (ECM) and Community Supports by incentivizing managed care plans, including CalOptima Health, to invest in provider capacity and delivery system infrastructure, integrate physical and behavioral health, reduce health disparities and promote health equity, and achieve improvements in quality performance.
Homeless Clinic Access Program (HCAP)
The Homeless Clinic Access Program provides accessible, reliable and quality medical care for members experiencing homelessness in Orange County by coordinating mobile clinics at shelter sites. The incentive dollars fund partnerships between homeless shelters and Federally Qualified Health Centers or community health centers.
Community Enrollers Program
CalOptima Health’s Community Enrollment Support Initiative aims to expand access to care for undocumented adults by partnering with organizations experienced in community enrollment and provider engagement.