Understanding CalAIM

About Calaim

California Advancing and Innovating Medi-Cal (CalAIM) is a state-led initiative aimed at improving the quality of care and health outcomes for Medi-Cal beneficiaries1. Governor Newsom describes CalAIM as, “a once-in-a-generation opportunity to completely transform the Medicaid system in California.”

More specifically, CalAIM provides a five-year roadmap to make Medi-Cal more equitable and person-centered2 by strengthening partnerships between managed care programs, community organizations, healthcare providers, counties, and the state legislature. Implementation of CalAIM began in January of this year and will continue into 2027.

CalAIM has several goals, including: 1) to address health disparities and promote health equity by improving access to care and addressing the social determinants of health; 2) to provide comprehensive, coordinated, and patientcentered care that addresses the physical, behavioral, and social needs to Medi-Cal beneficiaries; and 3) to emphasize value-based care rather than the volume of services provided (i.e., providers are paid based on quality of care and health outcomes).

Calaim Target Population

According to the California Health Care Foundation, CalAIM will serve the following patient populations:

• Those with significant behavioral health needs (e.g., mental illness, substance use disorder, etc.)

• Those experiencing homelessness

• Those transitioning from jail or prison back to the community

• Older adults and/or individuals living with disabilities

• Children with complex medical conditions (e.g., cancer, congenital heart disease, etc.)

• Children in foster care

Challenges To Implementation

There are several challenges to implementing CalAIM. There is a need for significant funding to implement and sustain the program amid on-going state budget cuts and other funding constraints. CalAIM involves significant changes to California’s Medicaid program, and implementing these changes will require significant funding.

Another challenge is the relatively small community workforce. CalAIM will require a well-trained and diverse workforce to deliver person-centered care and provide services in community-based settings; however, there may be challenges in recruiting and sustaining a sufficient number of qualified providers to meet the needs of the Medi-Cal population.

There are also challenges in the ability of many state and community organizations to collaborate and share data. CalAIM relies heavily on data to identify areas for improvement and track progress towards its goals; however, there may be challenges in collecting and analyzing this data, particularly in rural and underserved areas.

Finally, ensuring effective engagement and collaboration among a wide range of stakeholders, including patients, providers, community organizations, and policymakers requires significant effort on all parties and proves to be a challenge in implementation of CalAIM.

What Calaim Means For Physicians

CalAIM will affect clinical practice by changing the way in which care is delivered to Medi-Cal patients. Under CalAIM, providers will be expected to help provide holistic, person-centered care, including addressing the social determinants of health that may impact their patients’ health outcomes. They may also be required to participate in value-based payment models and focus on improving the quality of care and patient health outcomes.

Interested in learning more? The ACCMA is hosting an educational event in July centered around how and where physicians fit into CalAIM. More details coming to your inbox soon, or call ACCMA at (510) 654-5383 if you want to learn more.

Explore the following resources for more information about CalAIM:

• California Department of Health Care Services (DHCS) –DHCS.ca.gov/CalAIM provides a wide range of information about CalAIM as well as links to additional resources for providers and stakeholders.

• California Health Care Foundation (CHCF) – The CHCF is an independent, nonprofit philanthropy organization based in Oakland, California. CHCF works in collaboration with a wide range of stakeholders continued on page 17