CalAIM: Innovating MediCal

Recently, the Board of Supervisors received a presentation from the County Health Services Agency on the California Advancing and Innovating Medi-Cal (CalAIM) initiative.

CalAIM has the potential to transform and strengthen Medi-Cal — and will be a large implementation and coordination responsibility for the County. But what exactly is CalAIM and how will it impact our community and state?

What is CalAIM?

TheCalifornia Advancing and Innovating Medi-Cal, or CalAIM for short, is a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life.

Beyond direct health care funding, this initiative provides a new funding source for non-clinical interventions that impact health — social determinants such as housing vouchers, meals, community-based care coordination and more.

Whole-Person Care

Much of the current national approach to healthcare is fragmented — where physical and behavioral health, for example, are often treated separately.

CalAIM aims to break down these barriers through its whole-person care approach. Instead of treating patients as isolated cases, healthcare providers will consider their unique circumstances, addressing both their physical and mental well-being.

This holistic approach promises to enhance the quality of care and result in better health outcomes for individuals and communities alike.

For example, on the behavioral health side, CalAIM requires that the County develop standardized screening and transition tools, implementing a “No Wrong Door” policy to ensure beneficiaries receive treatment regardless of the delivery system in which they seek care.

The County established the “No Wrong Door” approach in early 2023, which includes implementation of statewide standardization of screening and transition tools that improve access and coordination of care. These tools streamlined criteria to improve access to care.

Reaching Those in Need

CalAIM expands the scope of services covered by Medi-Cal and the eligibility of Medi-Cal for specific populations, with the goal of ensuring all residents of Santa Cruz County have access to comprehensive care.

CalAIM leverages the Medi-Cal program as a tool to address many complex challenges facing the state’s most vulnerable residents, such as those who are experiencing homelessness, children with complex medical conditions, the growing number of justiceinvolved populations who have significant clinical needs, those needing behavioral health services, and the growing aging population. This will increase access to care and also decrease the financial burden of that care for these populations.

Sharing Data

CalAIM leverages technology -- which became common during COVID -- such as tele-health services and other digital health tools.

In addition, CalAIM looks to enhance data-sharing between systems to effectively serve communities. Movement towards a “one person, one record” model of data integration will significantly improve services by providing actionable data, developing consensus on how systems share data, and reducing duplication of efforts in service delivery.

The County continues to work on a cross-departmental effort to analyze our internal data system, assess the data infrastructure needs for community-based

By Zach Friend, Supervisor, Second District

organizations and make recommendations for efficiencies across its systems. Datasharing will support improved readiness for the continued rollout of CalAIM initiatives providing complex care coordination for higher-risk Medi-Cal beneficiaries.

This type of collaboration will ensure resources and efforts are allocated effectively to reduce duplication of services, enhance the “no wrong door” ideology deployed in County, and further the transparency and coordination of complex service delivery to improve the wellness of Santa Cruz County residents.

Healthcare Providers

What about the impact on healthcare providers in Santa Cruz County?

CalAIM does change some payment models and as with any transition there will be challenges during the implementation/transition period. But overall, the program intends to enhance payment models and streamline administrative processes, reducing the burden on providers. The goal is to reduce administrative/billing tasks so healthcare professionals will have more time to focus on what truly matters: Providing quality care to their patients. n

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As always, I appreciate any feedback you may have on this (or any other County issue). I’m maintaining regular updates on social media at www.facebook.com/supervisorfriend and you can always call me at 454-2200.