The California Advancing and Innovating Medi-Cal program is a multi-year plan to transform Medi-Cal.
It’s the state’s largest overhaul of how Medi-Cal services are delivered and paid since the implementation of managed care in the late 1970s.
According to a news release, the long-term mission of CalAIM is to offer more than 14 million Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory. The comprehensive program was developed by California’s Department of Health Care Services.
In Santa Barbara and San Luis Obispo counties, CenCal Health will implement CalAIM with its community partners.
CalAIM is designed to provide expanded services that go beyond traditional medical care, addressing social factors that affect human health from birth to end of life, including homelessness, behavioral health, care of older adults and services for individuals transitioning from incarceration.
“Our community partners have continuously been at the forefront of innovation, providing person-centered care to our members and underserved neighbors,” CenCal Health CEO Marina Owen said in a news release. “With the opportunities afforded by CalAIM, we are pleased to support our providers’ efforts to enhance, expand and strengthen local services.”
Under the CalAIM network, CenCal Health implemented two new initiatives: Enhanced Care Management and Community Supports.
ECM is a benefit for members with needs requiring seamless coordination between multiple doctors and other care providers. With ECM, enrolled members are assigned a lead care manager who helps coordinate doctors, specialists, pharmacists, case managers, and social service providers.
According to the news release, Community Supports provides medically appropriate and cost-effective alternatives to traditional medical services. Community Supports addresses the needs of members — including those experiencing homelessness, unstable and unsafe housing, food insecurity, and/or other social needs.
CenCal Health currently offers two Community Supports: Medically-Tailored Meals and Recuperative Care. Medically Tailored Meals provides meals to members with diabetes, congestive heart failure or chronic kidney disease, and who have had a skilled nursing facility stay, inpatient hospital visit, or two emergency room visits within t12 months.
Recuperative Care is medically-supervised respite care for patients who have just been released from the hospital due to serious illness or injury, and are experiencing homelessness or at risk of homelessness.
Community partners, shelters and local hospital providers Dignity Health, Cottage Health and Tenet Health have been offering recuperative care since 2019. Through CalAIM, CenCal Health will continue to support these critical services.
“Working together we can disrupt the cycle of preventable re-hospitalizations for those in our community experiencing homelessness,” Marian Regional Medical Center President and CEO Sue Andersen said in the news release. “It is great news that CalAIM and CenCal Health have made Recuperative Care an immediate priority in our county.”
Good Samaritan Shelter, PATH Santa Barbara, and Community Action Partnership of San Luis Obispo partner with the area hospitals to ensure an integrated referral and care coordination structure for members moving in and out of respite services. “Our shelter is committed to providing emergency, transitional and affordable housing with support services to the homeless and those in recovery throughout the Central Coast,” Sylvia Barnard, Good Samaritan Shelter executive director. said in a press release.