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.

Enhanced Care Management (ECM) and Community Supports Referral Forms Available

Beginning January 1, 2022, providers, community-based organizations, members, authorized representatives and family members will be able to submit a referral form to a member’s assigned health network if they feel the member would benefit from ECM or Community Supports services. The referral forms are available in the Resources section of this page as well as the member and provider sections of CalOptima’s website.

CalOptima CalAIM Model of Care (MOC) Approved

On December 17, 2021, DHCS confirmed approval of CalOptima’s CalAIM MOC. The MOC describes CalOptima’s plan to implement CalAIM. The full MOC consisted of policies and procedures, contract templates, and provider capacity information.

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 that 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.

Timeline Changes for Justice-Involved CalAIM Population of Focus

On November 15, 2021, DHCS informed CalOptima of the expectation to make ECM services available to Whole Person Care (WPC) justice-involved members while leveraging existing infrastructure and methods to identify members in this Population of Focus. CalOptima updated and resubmitted its MOC to include this population in its implementation plan for January 1, 2022.

Member Notices Sent

On December 1, 2021, all CalOptima members received a notice that either:

  • Described the new ECM benefit, or
  • Explained the transition of services to ECM and Community Supports if they were enrolled in WPC or the Health Homes Program

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.

ECM and Community Supports Provider Readiness Complete

CalOptima’s readiness assessment period for ECM and Community Supports providers occurred from September through December 2021. The readiness assessment ensured that providers have the capacity to start providing the required ECM and Community Supports services to eligible members on 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.  

Past 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.

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.

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