CalAIM, California’s multi-year initiative to transform Medi-Cal, has already met numerous key milestones regarding program implementation, which early data shows to have improved stabilization among enrollees. The Department of Health Care Services (DHCS) feels prepared to implement more going into the summer.
The purpose of CalAIM is to transform Medi-Cal into a more coordinated, person-centered, and equitable system of healthcare coverage. The first reforms were implemented in January 2022, with additional reforms being phased in through 2027. CalAIM’s 14 optional Community Supports act as a more affordable alternative to traditional medical services or settings, and are designed to address the social drivers of health.
As of Jan. 1st, Medi-Cal managed care plans (MCPs) launched a total of 247 new Community Supports services across all 58 counties, however San Francisco County will introduce Community Supports by Jan. 1st, 2024. Some of the most widely offered services include Housing Transition Navigation and Housing Tenancy and Sustaining services, as well as Medically-Tailored Meals.
Anthony Cava, spokesperson for DHCS’s Office of Communications, told State of Reform about what has been going well with the Medi-Cal transformation, and what challenges have arisen during the implementation process. He noted the widespread adoption of Community Supports.
“Every county in the state now has at least six Community Supports available, and 13 of those counties now have all 14 Community Supports available,” Cava said.
The phased implementation of all 14 Community Supports will continue to grow throughout this year.
Also on Jan. 1st, two new populations of focus—adults living in the community who are at risk of institutionalization, and adult nursing facility residents transitioning into the community— became eligible for CalAIM’s Enhanced Care Management benefits, which address both clinical and nonclinical needs of the highest-need enrollees through the intensive coordination of health and health-related services.
“DHCS expects that the number of enrolled members in Community Supports will continue to grow as more providers contract with MCPs to deliver services, providers develop their capacity, and members and their families learn about and connect to these services,” Cava said.
DHCS provided ECM and Community Supports providers who are new to Medi-Cal with several guidance documents to support their transition, which include billing and invoicing guidance, as well as national provider identifier application guidance.
“Through the first year of ECM and Community Supports implementation, DHCS performed regular surveys of the market, which indicated that ECM and Community Supports providers and MCPs were experiencing challenges with the variation in how information exchange was occurring to support the delivery of ECM and Community Supports,” Cava said.
Providers of ECM and Community Supports are receiving, and being asked to share, nonstandardized member level data elements with MCPs in a range of formats and transmission methods, which Cava said creates administrative burden and limits the overall uptake in ECM and Community Supports.
“DHCS is responding by developing guidance to define standards for members information exchange between MCPs and ECM and Community Supports providers for increased statewide standardization, as well as looking at authorization and payment processes to assess administrative burden and other barriers to uptake,” Cava said.
Cava also highlighted the Justice-Involved Initiative, which made California the first state in the nation to offer a targeted set of services to adults and youth in state prisons, county jails, and youth correctional facilities.
A key component of CalAIM is the Population Health Management (PHM) Program, which launched on Jan. 1st to create a cohesive and statewide approach for Medi-Cal managed care members to have access to a variety of services based on their needs and preferences.
“Under the PHM Program, MCPs and their networks and partners will be responsive to individual member needs within the community they serve while working with a common framework and set of expectations,” Cava said.
CalAIM also launched Medicare Medi-Cal Plans, also known as Medi-Medi plans, which is California’s program name for individuals who are dually eligible for Medicare and Medi-Cal. On Jan. 1st, 99.62% of members on Cal MediConnect plans—California’s previous dual-eligible plan—were automatically transitioned onto Medi-Medi plans, according to Cava.
Through Medi-Medi Plans, dually eligible individuals can enroll in a Medicare Advantage plan for Medicare benefits, and in a Medi-Cal MCP for Medi-Cal benefits, with both being operated under the same parent organization to improve care and coordination.
Effective July 1st, counties will move away from cost-based reimbursement and toward value-based reimbursement under CalAIM’s Behavioral Health Payment Reform initiative. This initiative aims to remove administrative burdens of the current fee-for-service reimbursement model in counties and implement more flexible payment models to promote quality care.
DHCS has provided counties and contracted providers with web-based training on numerous components of this transition, in collaboration with the County Behavioral Health Directors Association and California Mental Health Services Authority.
This training includes current procedural terminology coding, intergovernmental transfers, and best practices for business operations. Billing manuals, companion guides, and code reference guides were also flushed out as DHCS provides grants funding through the Behavioral Health Quality Improvement Program in order to implement the payment reform.
This July, ECM services will continue to expand to serve children and youth populations of focus. The CalAIM Contingency Management (CM) program also remains in the works, which aims to address stimulant use among the Medi-Cal population.
“CM is an evidence-based practice that recognizes and reinforces individual positive behavior change consistent with the non-use of stimulants,” Cava said. “In December 2021, DHCS received first-in-the-country approval from CMS to cover CM as a Medicaid benefit.”
According to Cava, DHCS intends to pilot Medi-Cal coverage of CM through the Recovery Incentives Program in the 25 participating counties from July 2020 to March 2024.
“Participating counties are in the process of completing training and readiness assessments of county staff and provider sites in advance of offering CM services,” Cava said.
Implementation training for eligible sites began this past February, and various sites have already completed training courses while working to complete readiness assessments.