California Launches CalAIM—Advancing and Innovating the State’s Medicaid Program

By Lucy Pagel, Senior Policy Consultant and Jennifer Ryan, Executive Vice President

This week, the California Department of Health Care Services (DHCS) announced the California Advancing and Innovating Medi-Cal (CalAIM) initiative. The intiative provides a roadmap for how the state proposes to continue to evolve its Medicaid program (Medi-Cal), and specifically its managed care delivery system, over the next decade.

The stated goals of CalAIM are to:

  • Identify and manage member risk and need through whole person care approaches and addressing the social determinants of health;
  • Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
  • Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems, and payment reform

CalAIM touches on nearly every aspect of the Medi-Cal delivery system and focuses on several of the state’s biggest priorities, including:

  • Combatting homelessness across the state;
  • Increasing access to integrated behavioral health care;
  • Serving children with complex medical conditions;
  • Providing continuity of care for justice-involved individuals; and
  • Continuing to advance care coordination for the aging population.

The Future of Medi-Cal
On October 29th, the state released a detailed series of CalAIM proposals that lay out the plans for achieving these priorities. The full implementation of the many innovative changes included in CalAIM will ultimately depend on several factors that will evolve over the coming years, including the state budget process.

In the meantime, DHCS is about to undertake a robust stakeholder workgroup process covering the key elements of the CalAIM proposals. The workgroup members, selected through an extensive application process, will play an important role in identifying opportunities and challenges related to sequencing, provider capacity, managed care contracting, and beneficiary and provider education. The key issue areas include:

  • Requiring Medi-Cal managed care plans to submit Population Health Management strategies and moving to an annual Medi-Cal managed care plan open enrollment period;
  • Adding a new Enhanced Care Management benefit and a set of In Lieu of Services primarily focused on combatting homelessness;
  • Continuing efforts toward behavioral health integration, payment reform, and delivery system transformation;
  • Requiring National Committee on Quality Assurance (NCQA) accreditation for all Medi-Cal managed care plans; and
  • Considering the creation of Full Integration Plans where one entity would be responsible for the physical, behavioral, and oral health needs of their members.

The proposals will be finalized at the conclusion of the workgroup process, in February 2020.  In the spring of 2020, the state will prepare the necessary documents to submit to the federal Centers for Medicare & Medicaid Services (CMS) for approval.Through CalAIM, the state is making the case that many of the integrated care strategies currently being tested – such as the Whole Person Care pilots, the Coordinated Care Initiative, and the Health Homes Program – have provided sufficient evidence of effectiveness that they should be taken to scale and implemented across the state.

CalAIM marks a significant change in the state’s approach to the federal-state Medicaid partnership. Due in part to recent changes to the “budget neutrality” requirement that is a condition of Section 1115 waivers, DHCS has decided to significantly limit its request for a waiver, instead favoring the more standard managed care waiver authority provided under Section 1915(b) of the Social Security Act. The California Health Care Foundation recently released an overview of the various authorities that are available through Medicaid, entitled Medi-Cal Explained

Through CalAIM, the state is making the case that many of the integrated care strategies currently being tested – such as the Whole Person Care pilots, the Coordinated Care Initiative, and the Health Homes Program – have provided sufficient evidence of effectiveness that they should be taken to scale and implemented across the state.

Harbage Consulting Role
Harbage Consulting is assisting DHCS with CalAIM through a comprehensive effort that includes facilitating the CalAIM workgroup process, providing strategic advice and technical assistance to the state and to the stakeholder community, conducting implementation planning, and assisting DHCS in its negotiations with CMS on the elements of CalAIM. We are proud to be able to continue our support for this important work, building off of our current work leading learning collaboratives for the Whole Person Care pilots, the Public Hospital Re-design and Incentives in Medi-Cal (PRIME) program, and the Health Homes Program, as well as our long-standing role in conducting provider and beneficiary outreach and education for the Coordinated Care Initiative (CCI).

To learn more about  CalAIM and the stakeholder workgroup process, including how to listen-in, please see the CalAIM webpage.

Harbage Consulting is proud to support the state on this important and exciting initiative! Stay tuned for updates as the work progresses.