California Advancing and Innovating Medi-Cal (CalAIM): Executive Summary and Summary of Changes



Authors: State of California Department of Health Care Services
Year: 2021
State: NatDoc: National Document
Website link: https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Executive-Summary-1-8-21.pdf
Publicly Available: Yes
Billing and Reimbursement:
Certification:
Evidence Generation:
Policy: Building partnerships, General other, MCO contract language and reimbursement models
Sustainable Financing: Engaging state partners in general, General other, How to engage and work with Medicaid, MCO or bundled payment reimbursement models, Documentation of how CHWs can work within care teams
Workforce Development: CDC expand CHW work into SDOH, Chronic Disease, General other (including mention of “employment practices”)

This proposal recognizes the opportunity to provide for non-clinical interventions focused on a whole-person care approach via Medi-Cal that target social determinants of health and reduces health disparities and inequities. Furthermore, the broader system, program, and payment reforms included in CalAIM allow the state to take a population health, person-centered approach to providing services and puts the focus on improving outcomes for all Californians. Attaining such goals will have significant impact on individuals’ health and quality of life, and through iterative system transformation, will ultimately reduce per-capita costs over time. DHCS intends to work with the Administration, Legislature and other partners on these proposals and recognizes the important need to discuss these issues and their prioritization within the state budget process. These are updated proposals based on extensive stakeholder feedback. Implementation will ultimately depend on the availability of funding and the requisite federal approvals. The “Summary of Changes” table at the end of this document summarizes major changes to the CalAIM proposal since its original release in October 2019.



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