California: Medi-Cal changes help simplify and add flexibility

Last modified: November 1, 2021

Starting Jan. 1, 2022, California Advancing and Innovating Medi-Cal (CalAIM) will begin to help move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility. CalAIM is a multi-year initiative by the California Department of Health Care Services that builds upon successful results of various pilots, including whole-person care (WPC), the health homes program (HHP) and a coordinated care initiative to:

• Identify and manage member risk and need through whole-person care approaches and by addressing social determinants of health
• Improve quality outcomes, reduce health disparities and drive delivery system transformation and innovation through value-based initiatives, systems modernization and payment reform

Enhanced care management (ECM) will provide community-based case management for UnitedHealthcare Community Plan of California members previously served in WPC pilots and HHP. Patients included are homeless or at risk of homelessness, have comorbidities or a pattern of high utilization. 

Community Supports are flexible wrap-around services, based on specific criteria and prior utilization patterns not traditionally included as Medi-Cal benefits, such as housing deposits, respite services, housing navigation and medical meals.

Over the next several years, patients in California Children’s Services, long-term care settings and jail-release programs will become eligible for ECM and Community Supports.

Questions? Contact Provider Services at 866-270-5785.

PCA-1-21-03471-C&S-News-09222021