5 Things California: CalAIM Recovery Incentives Program, NP independent practice, Medi-Cal spending projections


Eli Kirshbaum


In this week’s newsletter, we feature information on the upcoming CalAIM Recovery Incentive program for combatting stimulant use, recommendations for implementing the recently passed legislation to allow NPs to practice without physician supervision, and the Legislative Analyst’s Office’s predictions about Medi-Cal spending over the next few years.

Thanks for reading!

Eli Kirshbaum
State of Reform      


1. CalAIM Recovery Incentives program set to begin within next 2 months

After being delayed from its originally scheduled launch date this fall, DHCS says the CalAIM Recovery Incentives Program—a contingency management benefit intended to curb stimulant use among Medi-Cal beneficiaries—will now operationalize in December or January. DHCS delayed the launch date because it hadn’t selected an incentive manager for the program, but recently announced it has procured Pear Therapeutics to provide the incentive benefit.

This initiative is a pilot program that will be offered in DMC-ODS counties through March 2024, and is intended to inform the future creation of a statewide contingency management Medi-Cal benefit. Through the program, eligible Medi-Cal enrollees will receive incentives (in the form of low-denomination gift cards) in exchange for testing negative for stimulant use. Contingency management has been demonstrated to be an effective mitigation strategy for stimulant use.


2. CHCF offers guidance for implementing NP independent practice

Assembly Bill 890‘s passage this year positions California to permit nurse practitioners who meet certain criteria to practice without physician supervision starting in 2023. According to the California Health Care Foundation, several significant barriers will need to be overcome if the bill is to be implemented successfully. These include restrictive physician-to-NP ratio requirements, the cost of physician supervisors, and other administrative burdens.

Solutions, says CHCF, include raising public awareness about the critical role of NPs, enacting legislation to remove NP practice barriers like limitations on NP privileges and telehealth regulations, and providing NPs with the managerial/financial skills needed to practice independently. “If California NPs are to expand access to health care services, particularly in areas where practices do not already exist, they need to have business knowledge and skills to find funding and run their own businesses or expand practices within institutions,” CHCF says.


3. What They’re Watching: Alex Briscoe, California Children’s Trust

In this edition of our “What They’re Watching” series, Alex Briscoe, Principal at the California Children’s Trust, tells us about his passion for improving the way California serves the behavioral health needs of its children. Through his work in the 5-year California Children’s Trust initiative, Briscoe and his colleagues have developed comprehensive strategies for reforming the behavioral health safety net for kids, namely through the Children & Youth Behavioral Health Initiative.

“There’s a fundamental crisis—that we created—in the lives of children. So I’m very much focused on … how we teach young people to resist the toxic messages of this culture …  And I think we’re also acknowledging that Medicaid is the number one dominant actor in this space for kids. Six out of 10 kids are eligible for it. If we don’t get it right, we can’t fix it.”



4. LAO predicts short-term decreases, long-term increases in Medi-Cal spending

The Legislative Analyst’s Office recently published a report that predicts annual Medi-Cal spending will decrease over the next couple of years. Despite these predicted short-term decreases, however, LAO predicts Medi-Cal spending to increase over the long term and surpass $38 billion in 2026-2027. It attributes this growth to gradual caseload increases following the end of PHE continuous coverage requirements.

The LAO predicts Medi-Cal spending to be $35.5 billion in 2022-2023 and $34.2 billion in 2023-2024. It says the 2022-2023 decrease is attributable to the enhanced federal funding California is receiving through the PHE, and the 2023-2024 decrease is attributable to the winding down of several hefty behavioral health initiatives: the Children and Youth Behavioral Health Initiative, Behavioral Health Bridge Housing, and the Behavioral Health Continuum Infrastructure.


5. Study shows how pandemic economy is harming Californians’ mental health

A new report by the UCLA Center for Health Policy Research shows how the economic challenges of the pandemic have increased the risk of poor mental outcomes for California adults. Difficulty paying for housing and other basic necessities contributed to high levels of psychological distress for Californians in 2020, with these economic challenges having a disproportionate impact on non-white individuals.

The report provides recommendations for addressing these high levels of psychological distress in order to avoid long-term work and life impairment. These include expanding housing assistance programs for Californians, expanding eligibility and benefits for healthcare coverage, increasing funding for early education and child care programs, and ensuring equitable access to these services for vulnerable populations impacted by COVID-19.