What is Cal-AIM?
CalAIM, or California Advancing and Innovating Medi-Cal, is a multiyear process led by the California Department of Health Care Services to improve the health outcomes and quality of life experienced by Medi-Cal enrollees. It is scheduled to begin January 1, 2022.
CalAIM is a far-reaching, multiyear plan to transform California’s Medi-Cal program and to make it integrate more seamlessly with other social services. Led by California’s Department of Health Care Services, the goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs.
What are the goals of Cal-AIM?
- Make services more standardized and more equitable across the state, bringing consistency to the current patchwork of programs that vary by county.
- Ensure that the Californians who need the most help and support actually get it — by emphasizing proactive outreach to bring people with complex needs into care and offering a “no wrong door” approach to people seeking help.
- Enable Medi-Cal managed care plans to couple clinical care with a range of new nonmedical services. Those services, which will be reimbursed by Medi-Cal, include housing supports, medical respite, personal care, medically tailored meals, and peer supports.
- Require plans and incentivize public health systems to be more responsive, equitable, and outcome focused by:
- Focusing on population health, which involves matching the right patients to the right services at the right time, increasing equity.
- Implementing payment reform to lay the foundation for paying physical and behavioral health providers based on outcomes rather than services.
- Ensuring greater accountability for Medi-Cal managed care plans by requiring them to coordinate access to services provided by counties and community-based organizations.
Who will Cal-AIM help?
While CalAIM’s broad reach is intended to help all Medi-Cal enrollees, many of the reforms focus on improving care for people with the most complex needs. This group includes:
- People with significant behavioral health needs, including people with mental illness, serious emotional disturbance, and/or substance use disorder
- Seniors and people living with disabilities
- People experiencing homelessness who also have complex physical or behavioral health needs
- People transitioning from jail or prison back to the community who also have complex physical or behavioral health needs
- Children with complex medical conditions, such as cancer, epilepsy, or congenital heart disease
- Children and youth in foster care
Timeline for Cal-AIM Implementation:
The first reforms will start to be implemented in January 2022, and additional reforms will be phased in through 2027. Many of the activities that CalAIM will cover require a waiver approval from the Centers for Medicare & Medicaid Services, and that is expected to be finalized in December 2021. In the meantime, work is actively underway to ensure a smooth transition from existing programs to CalAIM once those first reforms are approved.
How is Exym Mental Health EHR Software Preparing for Cal-AIM?
Exym is focused on learning more about CalAIM so that our software can be compliant when deadlines and phases are more defined. We expect that specific phases will be rolled out in January 2022 and when that happens we will be ready to make sure our customers have what they need. Exym will continue to evolve as the focus in mental health is placed on client outcomes and whole person care.