California Advancing and Innovating Medi-Cal (CalAIM)
What is CalAIM?
The California Advancing and Innovating Medi-Cal (CalAIM) program, a five-year $6 billion initiative which began in January 2022, uses state contracted managed care plans (MCPs) to rebalance long term support and services (LTSS) and streamline care delivery to Medicaid recipients. CalAIM will pave the way for statewide Managed Long Term Support and Services (MLTSS) in 2027. For more information about CalAIM see the Department of Health Services webpage and CalAIM information graphic.
CalAIM has two components: Enhanced Care Management (ECM) and Community Supports (CS), known nationally as In Lieu of Services (ILOS). ECM will address clinical and nonclinical needs of the highest-cost and -need enrollees through intensive coordination of health and health-related services. CS gives MCPs the option of offering eligible members at the SNF level of care alternatives “in lieu of” expensive state plan services (e.g., Medi-Cal payments to SNFs). The expectation is ECM and CS will enable MCPs to provide medically appropriate and cost-efficient quality care, offer home and community based service (HCBS) alternatives to skilled nursing facilities (SNF) and save state and federal Medicaid dollars by reducing unnecessary hospital admissions, emergency department visits and SNF long-term placement. The MCPs offering ECM and CS will vary from county to county and not every ECM or CS will available to every MCP member in a county.
Enhanced Care Management (ECM)
ECM is a collaborative and interdisciplinary approach to provide comprehensive case management for clinical and non-clinical needs for high need Medi-Cal recipients. ECM will replace the Whole Person Care and Health Homes Program.
The goals of ECM include: improving care coordination, Integrating services, facilitating community resources, improving health outcomes, addressing social determinants of health and decreasing inappropriate utilization.
Community Supports (CS)
CS are optional services offered by MCPs that could help members avoid or provide a substitute to hospital or SNF admission, discharge delays and emergency department use.
CalAIM MCPs have the option of picking and choosing which CS to offer their members. A MCP has the option of offering or discontinuing a CS every six months.
The 14 allowable CS include:
Housing Transition Navigation Services
Housing Deposits
Housing Tenancy and Sustaining Services
Short-Term Post-Hospitalization Housing
Recuperative Care (Medical Respite)
Day Habilitation Programs
Caregiver Respite Services
Nursing Facility Transition/Diversion to Assisted Living Facilities
Community Transition Services/Nursing Facility Transition to a Home
Personal Care and Homemaker Services
Environmental Accessibility Adaptations (Home Modifications)
Medically Supportive Food/Meals/Medically Tailored Meals
Sobering Centers
Asthma Remediation
Connections is a contracted Community Support Provider for some CalAIM Managed Care Plans in Riverside/San Bernardino. See our CalAIM referral form.