California Advancing and Innovating Medi-Cal (CalAIM): High Level Summary




Year: 2020
State: CA
Website link: https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM/CalAIM-High-Level-Summary.pdf
Publicly Available: Yes
Billing and Reimbursement: Engaging state partners in general
Certification: CHW input in process, Role of state government, State input in process
Evidence Generation:
Policy: Legislative language, MCO contract language and reimbursement models
Sustainable Financing: General other, How to engage and work with Medicaid, Education to HC orgs on payment options bundled etc., MCO or bundled payment reimbursement models
Workforce Development: CDC expand CHW work into SDOH, Data sharing between social services and clinical teams

The Department of Health Care Services (DHCS) has developed a framework for the upcoming waiver renewals that encompasses broader delivery system, program and payment reform across the Medi-Cal program, called CalAIM: California Advancing and Innovating Medi-Cal. CalAIM advances several key priorities of the Administration by leveraging Medicaid as a tool to help address many of the complex challenges facing California’s most vulnerable residents, such as homelessness, insufficient behavioral health care access, children with complex medical conditions, the growing number of justice-involved populations who have significant clinical needs, and the growing aging population. DHCS intends to work with the Administration, Legislature and our other partners on these proposals and recognizes the important need to discuss these issues and their prioritization within the state budget process. These are initial proposals whose implementation will ultimately depend on whether funding is available.



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