A goal of the CalAIM initiative is to improve the health of California residents by supporting nonclinical interventions to address health-related social needs and to reduce health inequities. Two proposals in the CalAIM initiative are particularly relevant:
- A requirement for an Enhanced Care Management (ECM) benefit to address the clinical and nonclinical needs of those with complex health and social needs.
- Authorization for MCPs to deliver In Lieu of Services (ILOS) — cost-effective alternatives to covered services that improve health, such as housing navigation services. In developing plans for these services, MCPs can help to incorporate CHW/P services into member care.
Exhibit 2 and Exhibit 3 in the Resource Guide detail ECM priority populations and optional ILOS.
In addition to the opportunities presented by CalAIM, California is pursuing approval (PDF) from the Centers for Medicare & Medicaid Services to use federal Medicaid funds to support CHW/Ps in providing services as a benefit for Medi-Cal members, effective January 1, 2022. As details emerge on the types of services that CHW/Ps can provide, the structure of service provision, and how the services will be reimbursed, MCPs will have another opportunity to include CHW/Ps in providing services to members in their communities.
RELATED RESOURCE: Whole Person Care: The Essential Role of Community Health Workers & Peers (PDF) describes the roles of CHW/Ps in California’s Whole Person Care pilots.