Through its CalAIM (California Advancing and Innovating Medi-Cal) initiative, the California Department of Health Care Services (DHCS) seeks to offer a more equitable, coordinated, and person-centered approach that prioritizes whole-person care. One component of CalAIM includes building the infrastructure over time to provide managed long-term services and supports (MLTSS) statewide by 2027. This shift is intended to increase coordination, reduce siloes, and improve access to LTSS. (More information is available in the California Health Care Foundation report Medi-Cal Managed Care and Long-Term Services and Supports: Opportunities and Considerations Under CalAIM.) While a limited number of LTSS have been integrated into Medi-Cal managed care plan (MCP) contracts, In-Home Supportive Services (IHSS) - by far the largest Medi-Cal LTSS program and one that is expected to grow over time - remains outside of managed care. With the implementation of CalAIM and shifts in the Medi-Cal LTSS delivery system, policymakers and other stakeholders will need to consider both opportunities and challenges for the IHSS program, given its outsized role in the LTSS landscape and its unique operating model.
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