California Advancing and Innovating Medi-Cal (CalAIM) presents a significant opportunity for collaboration between community-based organizations (CBOs), local government agencies, and the Medi-Cal managed care system. People who work in these settings have profound knowledge, expertise, and deep relationships with communities and are skilled at addressing patients’ physical health, behavioral health, and social needs. CalAIM creates an avenue for these organizations to contract with Medi-Cal managed care plans and be reimbursed for services.
To provide a solid starting point for providers who are navigating their involvement in CalAIM’s Community Supports and Enhanced Care Management, CHCF has collected a manageable number of resources below in the following categories: (1) Understanding CalAIM, (2) Readiness and Planning, (3) How to Get Involved, and (4) Additional Engagement Opportunities.
Understanding CalAIM
CalAIM is a five-year initiative aspiring to transform Medi-Cal to be grounded in equity, to take on person-centered approaches, and to maximize the health of Californians. There are several ways that new providers can become involved in CalAIM.
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Engaging with CalAIM: Quick Links for Community-Based Organizations: This one-page flyer highlights the role of new providers, available implementation funds, and opportunities to get involved and obtain sustainable Medi-Cal funding through CalAIM. While geared to CBOs, it applies to any provider who is new to Medi-Cal managed care. (ITUP)
Medi-Cal Community Supports Explainer (PDF)
Community Supports are services not traditionally covered through Medi-Cal and are meant to address the health-related social needs of eligible members. (Aurrera Health Group)
PATH Fact Sheet (PDF)
Providing Access and Transforming Health (PATH) is a CalAIM initiative focused on capacity building and infrastructure, for community providers to better serve Medi-Cal members statewide. Visit the DHCS PATH web page to learn more. (DHCS)
CalAIM: Community-Based Organizations Poised to Partner with Medi-Cal
This blog post overview provides examples of how integral CBOs are to the vision and potential of CalAIM implementation. (CHCF)
Exploring Emerging Medi-Cal Community Care Hubs
Learn about Medi-Cal community care hubs and how they support providers participating in CalAIM and the community health worker and doula benefits. (Aurrera Health Group)
On-Demand Resource Library
If your organization wants to learn more about CalAIM and CA PATH, this library of resources includes websites, videos, webinar recordings and more. They are suitable for organizations at all levels of readiness for Enhanced Care Management, Community Supports, and the Justice-Involved initiative. (DHCS)
Readiness and Financial Planning
The following resources may help your organization determine if partnering with a Medi-Cal managed care plan to provide service through CalAIM is the right fit. While most of these tools are not CalAIM specific, they can help you examine several factors relevant to contracting with a managed care plan.
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Assessing Feasibility and Readiness
These tools are available in different formats that require different levels of engagement.
Nonprofit Readiness for Health Partnership
This readiness tool supports providers in assessing key capacities so they can be well positioned to partner with health care organizations. It includes 32 questions across six areas — organizational fit with partnership, financial capabilities, service delivery, measuring performance, people, and partnerships and networks. This tool is available as a downloadable Excel file. (Nonprofit Finance Fund)
Partnership Readiness Assessment
This more extensive tool supports providers in gauging their readiness for health care partnership and provides guidance on successfully preparing, securing, and maintaining contracts. This assessment is completed in a web browser. While the tool is free to use, an account is required to access it. (Aging and Disability Business Institute)
Financial Planning
CalAIM Budget Estimator Tool
The CalAIM budget estimator tool is an Excel-based template that organizations can use to estimate costs and potential revenue associated with providing Medi-Cal Enhanced Care Management and a sample of Community Supports services, including housing-related services and medically tailored meals. (Camden Coalition)
Health Care and Community-Based Organization Partnership: What Does It Cost? (Excel)
This tool provides a simplified framework to help CBOs and other organizations assess their total estimated cost of partnering with health care organizations. (Nonprofit Finance Fund)
Budget and Financial Planning Tool
This tool helps CBOs and other organizations to develop project-specific budgets and to plan for project-related financial sustainability over a five-year time frame. (Scan Foundation)
How to Get Involved
Not sure how to partner with a managed care plan and get involved in CalAIM? These resources provide information to help you get started.
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Medi-Cal Explained: 2024 Medi-Cal Managed Care Plans by County
In 2024, many California counties will experience major changes around which Medi-Cal managed care plans operate there. This short resource offers county-by-county breakdowns of where managed care plans will operate next year — along with noteworthy changes, such as when an existing plan is exiting a region and when a new plan is taking on responsibility for enrollees in the area. (CHCF)
Get Ready: A Contracting Best Practices Guide for Becoming a Medicaid Community Supports Provider (PDF) This resource provides step-by-step guidance on thinking through the contracting process to become a Community Supports provider in CalAIM. (HealthBegins)
Video: Contracting with Managed Care Plans (CalAIM Links2022 Statewide Session No. 2)
Learn about contracting with managed care plans in this video starting at 37:00 and running through 52:30. (HealthBegins)
Medi-Cal Academy for Homeless Service Providers
This training series is designed for housing and homeless service agencies interested in contracting with managed care plans to provide housing-related Community Supports. The training series also has an updated billing guide for Community Supports providers. Be sure to check it out! (Corporation for Supportive Housing)
Model Contracts for Community-Based Integrated Care Networks
This resource has three model contracts that provide examples of ways networks can frame their contractual relationships. While these sample contracts are not CalAIM specific, they can inform contracting with a managed care plan. (Aging and Disability Business Institute)
Additional Engagement Opportunities
Options for technical assistance and information are available at the links below.
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Braiding Medicaid Funding to Support Person-Centered Care: Lessons from Medi-Cal
Braiding Medi-Cal and non-Medi-Cal funds can help health care and social service organizations maximize funding and sustainably provide person-centered care. This brief profiles three organizations that successfully implemented strategies to braid funds and provides strategies to successfully braid funding. (Center for Health Care Strategies)
Collaborative Planning and Implementation
Stakeholders in regional collaborative planning groups are working together to identify how PATH and other CalAIM funding initiatives can address ECM and Community Supports program implementation gaps and improve outcomes. CBOs and other county-based providers are strongly encouraged to participate and can register here. (DHCS)
TA Marketplace
The CalAIM PATH Technical Assistance (TA) Marketplace launched in January 2023 to provide no-cost support for organizations working to implement CalAIM’s Enhanced Care Management and Community Supports. TA offerings include off-the-shelf project resources and connections for hands-on TA. A managed care contract is not required to participate in the marketplace. (DHCS)
Billing Better in CalAIM
This issue brief outlines key challenges with each step of the billing process and provides recommendations for addressing them. (CHCF)
Housing-Related Community Supports
Housing and homeless service providers may want to share this helpful guide with their managed care plan partners. The handbook is intended for leaders in health care plans. (CHCF)
Food as Medicine Collaborative Technical Assistance Resources
The Food as Medicine Collaborative website features TA resources and tools (such as a readiness assessment survey) for health entities interested in providing medically supportive food and nutrition services through CalAIM. (Food as Medicine Collaborative)
Not familiar with the basics of Medi-Cal? Learn more at “The Medi-Cal Program: An Overview” and “Medi-Cal Explained.”
To keep current on CalAIM and for most recent policy documents, visit the CalAIM section or the ECM and Community Supports page of the California Department of Health Care Services (DHCS) website and subscribe to DHCS’s stakeholder email list.
Finally, CHCF sends monthly CalAIM updates. Sign up to receive it.
