CalAim Update – Very Important for All California providers

The CalAIM program includes a series of far-reaching initiatives that represent broad reforms to Medi-Cal’s programs and systems. These changes will span a multi-year period, with the first reforms implemented in January 2022 and additional reforms phased in through 2027. 

Under CalAIM, institutional Long-Term Care (LTC) will be carved-in to Medi-Cal managed care in all counties in 2023, making coverage consistent across California. 

Currently, the Medi-Cal LTC benefit is carved-in to Medi-Cal managed care in the following 22 County Organized Health System (COHS) and seven Coordinated Care Initiative (CCI) counties. 

• Coordinated Care Initiative (CCI) Counties: Los Angeles, Orange, Riverside, San Bernardino, San Mateo, San Diego, and Santa Clara.

• County Organized Health Systems (COHS) Counties: Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, and Yolo.

Note: Orange and San Mateo are COHS counties that are also CCI counties.

In the remaining 31 counties, institutional LTC coverage by MCPs is limited to the first month of admission and the following month. Members are disenrolled from the MCP to Medi-Cal fee-for-service after the second continuous month of admission in a SNF facility. 

THIS IS CHANGING. 

Under CalAIM, institutional LTC will be carved-in to Medi-Cal managed care in ALL remaining counties effective January 1, 2023. At that time, all MCPs will become responsible for the full LTC benefit at Skilled Nursing Facilities (SNF), including a distinct part or unit of a hospital. 

YES. THIS January 1, 2023

There are a number of stated goals of the Medi-Cal LTC carve-in, and you can read about them here.

What You Need to Do Now:

For All California Providers: It is critical to be prepared. Click on the link below to review the list of health plans by county and be sure you are in touch with the health plans in your area so you are ready to admit Medi-Cal residents and get paid on time.