CalAIM Waiver Applications Approved by CMS

On December 29, 2021, the Department of Health Care Services (DHCS) received approval of the CalAIM Section 1115 demonstration waiver, CalAIM Section 1915(b) waiver, and Medi-Cal State Plan Amendments from the federal Centers for Medicare & Medicaid Services (CMS) through December 31, 2026.

California is using several federal authorities that provide the state more flexibility to carry out CalAIM initiatives with the goal of scaling innovations statewide and aligning how care is provided across delivery systems. These waivers and key authorities launch the implementation of CalAIM and pave the way for Medi-Cal to be more equitable, coordinated, and person-centered to help people maximize their health and life trajectory. 

The key provisions related to the behavioral health and justice-involved population include:

  • Delivery System Transformation and Alignment shifts in California’s managed care deliver systems to one coordinating authority.
  • Enhanced Care Management addresses clinical and non-clinical needs of the highest-need Medi-Cal enrollees through intensive coordination of health and health-related services.
  • Community Supports provides new statewide services covered by Medi-Cal managed care plans as medically appropriate alternatives to traditional medical services or settings.
  • Providing Access and Transforming Health (PATH) Supports provides funding to community-based organizations, counties, and other local providers to support capacity building as they begin to implement and scale Enhanced Care Management and Community Supports. PATH will support justice-involved adults and youth by sustaining the pre-release and post-release services.
  • Substance Use Disorder Services and Initiatives advances treatment of individuals with substance use disorder, including reauthorizing the Drug Medi-Cal Organized Delivery System with a contingency management benefit for treatment of stimulant use disorder, and Peer Support Specialists who will offer competent services to promote recovery.

DHCS is still working on negotiating some of the 1115 demonstration waiver components, including those related to the justice-involved population.

Additional information can be found on DHCS’ CalAIM 115 Demonstration & 1915(b) Waiver website.