California Advancing and Innovating Medi-Cal (CalAIM) presents a significant opportunity for collaboration between community-based organizations (CBOs) and the Medi-Cal system. People who work at CBOs 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 CBOs to contract with Medi-Cal managed care plans (MCPs) and be reimbursed for services.
To provide a solid starting point for CBOs who are navigating their involvement in CalAIM, 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 CBOs can become involved in CalAIM.
Engaging with CalAIM: Quick Links for Community-Based Organizations: This one-page flyer highlights the role of CBOs, available implementation funds, and opportunities for CBOs to get involved and obtain sustainable Medi-Cal funding through CalAIM. (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)
Enhanced Care Management (ECM) Provider Toolkit (PDF)
Enhanced Care Management (ECM) addresses clinical and nonclinical needs through coordination of services and comprehensive case management for Medi-Cal members. This toolkit provides information about what ECM is, who it serves, and what is expected of those who provide ECM. (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 (including CBOs) 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)
The Role of CBO Networks in CalAIM: Seven Key Considerations
This brief explains the roles, opportunities, and challenges that CBO networks present in CalAIM. (CHCF)
Readiness and Planning
The following resources may help your organization determine if partnering with a Medi-Cal managed care plan (MCP) to provide service through CalAIM is the right fit. While these tools are not CalAIM specific, they can help you examine several factors relevant to contracting with an MCP.
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 CBOs 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 CBOs 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
Health Care and Community-Based Organization Partnership: What Does It Cost? (Excel)
This tool provides a simplified framework to help CBOs assess their total estimated cost of partnering with health care organizations. (Nonprofit Finance Fund)
Budget and Financial Planning Tool
This tool helps CBOs 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 an MCP and get involved in CalAIM? These resources provide information to help you get started.
Medi-Cal Managed Care Health Plan Directory
This directory features a list of Medi-Cal managed care health plans by county. Most MCPs have pages on their websites dedicated to CalAIM including contact names and ways to engage. (DHCS)
Video: Contracting with Managed Care Plans (CalAIM Links2022 Statewide Session No. 2)
Learn about contracting with MCPs in this video starting at 37:00 and running through 52:30. (HealthBegins)
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 an MCP. (Aging and Disability Business Institute)
Additional Engagement Opportunities
Options for technical assistance and information are available at the links below.
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 will launch in January 2023 to provide support for organizations — including CBOs — working to implement CalAIM. TA offerings will include off-the-shelf projects resources and connections for hands-on TA. (DHCS)
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.