CalAIM, California’s five-year effort to transform the state’s Medi-Cal program, is one of the nation’s most comprehensive and far-reaching efforts to make Medicaid truly patient centered, especially for the people with the most complex health and social needs. Before CalAIM, counties in California tested new approaches to better serve people with complex needs through a program called Whole Person Care (WPC). Each county had its own approach, and most provided direct services in addition to administering the pilot.

The most successful services from the WPC program have been expanded statewide through CalAIM as two programs: Enhanced Care Management (ECM) and Community Supports. However, the responsibility for administering those services has shifted from the counties to managed care plans. Despite this change, counties still play an important role as care providers and partners to managed care plans and as local organizations that support this group of enrollees with high needs.

This brief focuses on how four counties — Alameda, Contra Costa, Placer, and Ventura — have adapted to CalAIM. They now act as interme­diaries between managed care plans and local providers while continuing to care directly for people with complex health and social needs.

In this brief, we interviewed county health administrators responsible for implementing ECM and Community Supports in their counties. They discuss what has worked well and what still needs improvement in the implementation of CalAIM.

Their comments revolve around these themes:

Services

• Housing needs to be a top priority.
• Integrating behavioral health into a seamless web of services is critically important.

Administration

• Workforce hiring, training, and retention is a challenge.
• Data exchange and a strong information tech­nology infrastructure are essential.

Cost and billing

• Billing for services is different than under WPC.
• Payments do not cover the costs of services provided.