CalAIM Overview
California Advancing and Innovating Medi-Cal (CalAIM) is a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory.
Goals of CalAIM
- Identify and manage comprehensive needs through whole person care approaches and social drivers of health.
- Improve quality outcomes, reduce health disparities, and transform the delivery system through value-based initiatives, modernization, and payment reform.
- Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility.
CalAIM Initiatives and Services
- Providing Access and Transforming Health (PATH)
Learn more about PATH and how to apply for PATH and CITED funds. CalAIM will build up the capacity and infrastructure of on-the-ground partners, such as community-based organizations (CBOs), public hospitals, county agencies, tribes, and others to successfully participate in the Medi-Cal delivery system as California widely implements Enhanced Care Management and Community Supports and Justice Involved Services.
- Population Health Management Managed care plans will be required to implement a whole-system, person-centered strategy that includes assessments of each enrollee’s health risks and health-related social needs, focuses on wellness and prevention, and provides care management and care transitions across delivery systems and settings. Learn More
- Enhanced Care Management
Enhanced Care Management is person-centered care management provided to the highest-need Medi-Cal enrollees, primarily through in-person engagement where enrollees live, seek care, and choose to access services. Learn More
- Community Supports (also known as “In Lieu of Services”)
Medi-Cal managed care plan partners will begin offering “Community Supports,” such as housing supports and medically tailored meals, which will play a fundamental role in meeting enrollees’ needs for heath and health-related services that address social drivers of health. Learn More
- New Dental Benefits
CalAIM will expand key dental benefits statewide, including a tool to identify risk factors of dental decay, and silver diamine fluoride for children and certain high-risk populations. Statewide pay-for-performance initiatives will reward dental providers for focusing on preventive services and continuity of care. Learn More
- Behavioral Health Delivery System Transformation
DHCS will strengthen the state’s behavioral health continuum of care for all Californians and promote better integration with physical health care. CalAIM will streamline policies to improve access to behavioral health services, simplify how these services are funded, and support administrative integration of mental illness and substance use disorders treatment. Learn More
- Services and Supports for Justice-Involved Adults and Youth
These initiatives help California address poor health outcomes and disproportionate risk of illness and accidental death among justice-involved Medi-Cal eligible adults and youth as they re-enter their communities. Learn More
- Statewide Managed Long-Term Care
CalAIM will transition institutional long-term care to managed care statewide to better coordinate care, simplify administration, and provide a more integrated experience. Learn More
- Integrated Care for Dual Eligible Beneficiaries
Through CalAIM, DHCS is implementing policies that promote integrated and coordinated care for dual eligible beneficiaries, including the statewide expansion to Medicare Medi-Cal Plans (MMPs or Medi-Medi Plans) - a special kind of Medicare Advantage Plan that coordinates Medicare and Medi-Cal benefits for beneficiaries who are eligible for both programs. Learn More
- Standard Enrollment with Consistent Managed Care Benefits
To improve each enrollee’s experience, CalAIM will expand the use of managed care plans and standardize benefits so that each enrollee will have access to a consistent set of services, no matter where they live.
- Delivery System Transformation
CalAIM will explore other ways to improve care, including developing a long-term plan of action for foster youth, seeking a federal waiver for short-term residential treatment for enrollees with a Serious Mental Illness or Serious Emotional Disturbance, and piloting full integration of physical health, behavioral health, and dental health in one managed care plan.
Additional Resources
