CalAIM Waiver Officially Submitted
July 15, 2021
The Department of Health Care Services (DHCS) submitted the state’s massive proposal to streamline and simplify Medi-Cal, dubbed the California Advancing and Innovating Medi-Cal (CalAIM), on June 30.
The CalAIM initiative encompasses a wide swath of changes to Medi-Cal, and currently spans two separate federal waiver proposals:
- Section 1115 Medicaid Waiver Proposal: https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Section-1115-Renewal-Application.pdf
- Section 1915(b) Specialty Mental Health Services Waiver Proposal: https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-1915b-Waiver-Proposal.pdf
Both waivers are requested for a period starting January 1, 2022 through December 31, 2026. Additional pieces of CalAIM, including a possible waiver request to eliminate or modify the federal Institutes for Mental Disease (IMD) exclusion, may be submitted next June or later.
CalAIM provides critical funding for county-run public hospitals and will modernize the reimbursement system for county specialty mental health services. While CSAC is broadly supportive of CalAIM, members remain concerned about the role of counties in its implementation, including coordinating with existing county efforts, allowing counties the right of first refusal to coordinate Enhanced Care Management and In Lieu of Services benefits, and allowing counties to be directly eligible for incentives.
The Legislature is also advancing two policy bills (AB 1132 [Wood] and SB 256 [Pan]) to authorize and implement CalAIM, and work will begin in earnest on those efforts in August when the legislative session reconvenes. Note that California can’t implement CalAIM until it negotiates the terms and conditions of the waivers and receives final approval from CMS, hopefully by December 31 of this year.