California Re-Commits to CalAIM Initiative for 2021

On January 8, 2021, California’s Governor Gavin Newsom released his proposed budget for fiscal year 2021-2022, which includes a restoration of funding for the California Advancing and Innovating Medi-Cal (CalAIM) initiative ($1.1 billion in 2021-2022 and $1.5 billion in 2022-2023). The initiative – which was initially launched in October 2019 but placed on hold in the spring of 2020 due to the impact of the COVID-19 public health emergency on the state’s health system – is a multi-year initiative lead by California’s Medicaid agency, the Department of Health Care Services (DHCS) to “improve the quality of life and health outcomes of our population by implementing broad delivery system, program and payment reform.”The CalAIM initiative has many facets. Aurrera Health Group supported DHCS in an extensive four-month stakeholder engagement process following the October 2019 release of the initial proposal and has continued to support policy development and implementation planning, as well as stakeholder engagement. The CalAIM re-launch signals a significant commitment to a statewide approach to delivering “whole person care” through a new enhanced care management benefit that will be augmented by a series of optional ‘in lieu of’ services – like recuperative care services/medical respite, housing tenancy supports, and medically-tailored meals – designed to address the social needs that can contribute to overall health.

CalAIM and Whole Person Care

In addition to supporting the finalization of the CalAIM proposal, Aurrera Health Group continues to lead the Whole Person Care Learning Collaborative that has been underway since 2016. Whole Person Care (WPC) is a pilot program authorized under the state’s Medi-Cal 2020 1115 demonstration, (recently extended through December 31, 2021). Together with the Health Homes Program, the Whole Person Care pilots have played a vital role informing key components of the CalAIM initiative, most notably the inclusion of the enhanced care management benefit and a set of ‘in lieu of’ services mentioned above.To facilitate and support this transition, Aurrera Health Group worked with WPC pilot programs to collect promising practices that align with the enhanced care management benefit and in lieu of services in order to clearly demonstrate the opportunity for partnership and shared learning. In December, we published a report entitled Whole Person Care: A Roadmap for Enhanced Care Management and In Lieu of Services that documents learnings from the WPC pilots on the following topics:

• Enhanced Care Management

  • Outreach and engagement

  • Care coordination

• In Lieu of Services

  • Housing Transition Navigation Services

  • Housing Deposits

  • Housing Tenancy and Sustaining Services

  • Respite Care

  • Sobering Centers

The goal of the paper is to demonstrate the value of the services the WPC pilots are providing and strategies for developing successful pathways to providing these critical services statewide.  Medi-Cal managed care plans can leverage the WPC pilot counties’ expertise as service providers to ensure a streamlined and consumer-friendly transition to ECM and ILOS.

Next Steps

Aurrera Health Group will continue to support the Whole Person Care Learning Collaborative as well as the Health Homes Program in hopes of further exploring lessons learned from and providing technical assistance to WPC pilots throughout 2021 as they work with Medi-Cal managed care plans on the transition to enhanced care management and in lieu of services and to support the CalAIM initiative broadly.

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Lucy Pagel [Director]