Counties lean into CalAIM
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Perspectives from the field
- Author(s):
- Moore, J. Duncan, Jr., author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, October 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Community Health Services Delivery of Health Care, Integrated Government Programs Health Care Reform Local Government Medicaid -- organization & administration Social Determinants of Health State Health Plans -- organization & administration California
- Genre(s):
- Technical Report
- Abstract:
- The state of California’s comprehensive Medicaid reform effort, known as CalAIM (California Advancing and Innovating Medi-Cal), is one of the nation’s most comprehensive and far-reaching efforts to make Medicaid truly patient centered. The need for these reforms is felt most strongly by people with complex health and social needs, such as those with medical conditions who are also experiencing homelessness, living with serious mental illness or substance use disorder, or returning to the community after incarceration. Prior to CalAIM, California’s counties piloted innovative approaches to better serving people with complex needs through an initiative known as Whole Person Care (WPC). Under WPC, each pilot was administered directly by counties that opted in and contributed local dollars to match federal resources to fund the program. Each county developed its own approach, and most counties provided direct services in addition to administering the pilot. The most promising services piloted in WPC have since been scaled up statewide through CalAIM in the form of two programs: Enhanced Care Management (ECM) and Community Supports. However, the responsibility for administering those services has been passed from the counties to managed care plans (MCPs). Funding now flows through Medi-Cal MCPs and has moved away from a grant-like structure under WPC to fee-for-service, capitated, and bundled payment structures under ECM and Community Supports. Yet, California’s counties still have important contributions to make. They are critical providers of care, as well as partners to both the MCPs and local organizations that support this high-need group of enrollees. This brief highlights how select counties have adapted to CalAIM and are now acting as intermediaries between MCPs and local providers while also continuing to care directly for people with complex health and social needs.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (10 pages))
- NLM Unique ID:
- 9918734180506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918734180506676