What's CalAIM?
CalAIM, or California Advancing and Innovating Medi-Cal, is an initiative aimed at transforming California's Medi-Cal program to improve health outcomes for its members. It focuses on addressing social determinants of health and enhancing access services through a more integrated approach.
By implementing innovative strategies expanding care coordination, CalAIM seeks to provide comprehensive support to vulnerable populations across the state.
To learn more about CalAIM and California's innovation please click the link below.
Enhanced Care Management (ECM) is a key service under CalAIM designed to provide intensive, personalized care coordination for individuals with complex needs. ECM is targeted at people experiencing homelessness, individuals with multiple chronic conditions, seniors, people with disabilities, foster youth, and those with serious mental illness or substance use disorders. Through ECM, participants receive one-on-one support from a dedicated care manager who helps them navigate the health system, access medical and behavioral health services, secure housing, and connect with critical social services. The focus is on addressing both clinical and non-clinical needs in a highly integrated, hands-on way, helping individuals achieve better health outcomes and greater stability in their daily lives.
Community Supports (CS), formerly referred to as "In Lieu of Services," are non-traditional but medically appropriate services offered under CalAIM to address social determinants of health. CS services include housing-related supports like help finding and maintaining stable housing, short-term post-hospitalization housing, medically tailored meal programs, home modifications to improve accessibility, and asthma remediation services. Additionally, services like respite care for caregivers, personal care/homemaker services, and access to sobering centers are part of the offering. These supports are designed to prevent more costly or intensive medical interventions by tackling environmental and social barriers to health, thus promoting overall wellness in ways traditional medical services might miss.
The Behavioral Health Reforms under CalAIM aim to better integrate and simplify mental health and substance use disorder services for Medi-Cal members. Previously, individuals had to navigate separate systems depending on the severity of their conditions. Now, under CalAIM, there is a more seamless approach where patients receive the right level of care without unnecessary hand-offs or administrative hurdles. The goal is to create a unified behavioral health system that improves access, continuity of care, and health outcomes for people with mental illness, emotional disturbances, and substance use challenges.
Population Health Management (PHM) under CalAIM represents a shift toward a more proactive, data-driven healthcare model. Instead of waiting for serious health issues to arise, Medi-Cal managed care plans are now required to identify risks early and intervene appropriately. This involves using health data to predict when members may need additional support and connecting them to services like ECM or Community Supports before problems escalate. PHM ensures a more preventive, person-centered approach that focuses on keeping members healthier and reducing unnecessary hospitalizations or crises.