California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year effort to change the state’s Medi-Cal program. This broad reform focuses on improving health outcomes and the quality of life for people across California. It represents a major move to modernize the system through new programs, payment structures, and better ways to deliver care
The Goals of CalAIM
CalAIM is reshaping Medi-Cal by looking beyond the doctor’s office. It integrates mental health and substance use care with physical healthcare, while also tackling social needs like housing and nutrition. The initiative promotes equity by reducing racial and ethnic health disparities and simplifies the system with reforms—such as new payment models that reward quality of care instead of outdated cost-based methods.
Core Services and Initiatives
Enhanced Care Management (ECM): Extra support for Medi-Cal members with complex needs. A Lead Care Manager helps coordinate medical, mental health, and social services.
Community Supports (In Lieu of Services): Cost-effective alternatives to hospital care, like housing help, home modifications, or meal programs, offered through Medi-Cal managed care plans.
Who Can Use CalAIM Services?
CalAIM is designed to improve the Medi-Cal experience for all members, but some services are reserved for people with the highest needs. For example, Enhanced Care Management and Community Supports are targeted toward specific groups that face complex health and social challenges. These groups, often called Populations of Focus, include :
– People experiencing homelessness or at risk of losing their home
– Adults and children with serious mental health or substance use needs
– People transitioning back into the community after being in jail or prison
– Nursing facility residents who are moving back home or to the community
– Children in foster care or those with complex medical conditions who need extra support
– Individuals who are pregnant or in the postpartum period
Putting CalAIM Into Action
The California Department of Health Care Services (DHCS) leads the CalAIM initiative. Medi-Cal managed care plans are responsible for delivering many of these new benefits, such as Enhanced Care Management and Community Supports. These plans work with local providers and community organizations to ensure members get the help they need.
This reform is happening in stages, with the first changes starting in January 2022 and more updates scheduled through 2027. To help partners get ready, the state created the PATH initiative, which provides funding and technical support to hospitals, county agencies, and community groups. This initiative builds on lessons learned from earlier pilot programs to help make these services available statewide
