Medi-Cal Transformation is evolving, and the lessons learned since its launch in 2022 have created significant discussion throughout California and other states regarding opportunities to push Medicaid and state waiver programs forward with the evolving healthcare landscape. Medi-Cal Transformation, formerly known as California Advancing and Innovating Medi-Cal (CalAIM), is reshaping the state’s Medicaid system to better serve California’s highest need and most vulnerable populations through the integration of critical social services and individualized care for participants.

At its core, the initiative aims to bring health care and social services into better alignment to reduce fragmentation for participants to access care. Over the past several years, community organizations, local agencies, and providers across California have discovered more effective, person-centered ways to support Medi-Cal members. Key takeaways include:

1. Streamlined Management of Complex Members: CalAIM has shown that proactive, personalized care planning, anchored by a Lead Care Manager serving as a single point of contact, helps reduce fragmentation and improves outcomes for individuals with high medical, behavioral, and social needs.
2. Integration of Lived Experience: Utilizing care team members such as case managers and community health workers who share similar backgrounds with members has created deeper trust and more culturally responsive care.
3. In-person Connection: Face-to-face interactions remain vital, especially for vulnerable populations, and have helped tremendously to build relationships, identify unmet needs, and reduce barriers to care.
4. Integration of Community Support Services Beyond Traditional Providers: Collaborating with housing agencies, food programs, and other non-clinical partners has positively impacted resource availability for services that help to address clinical and non-clinical service needs across the identified population.
5. Comprehensive Closed-loop Care Coordination: Real-time communication and data-sharing between care managers and various points of care, including primary care, specialists, and community support providers, ensures nothing falls through the cracks and supports seamless whole-person care delivery.

Where do we see CalAIM heading next? As we look at the next phase of this transformation, CalAIM is not slowing down. Instead, it is evolving into a more targeted and strategic framework, with new models designed to serve distinct populations more effectively. Two key trends are emerging and will continue to shape the future:

ECM is here to stay, and it’s becoming more focused: ECM remains a cornerstone of CalAIM and will not be going away. As the initiative continues to evolve, we expect more focused implementation strategies that align with gaps identified for

ECM populations, including:

• Justice-Involved Initiative (JII): California became the first state to receive federal approval under a 1115 waiver to offer targeted Medi-Cal services for eligible members in correctional facilities (CF) through the CalAIM Justice-Involved Initiative (JII), which aims to improve reentry outcomes through pre-release health services and reentry planning. CalAIM JII Pre-release Services for all CF must go live between October 1, 2024 to September 30, 2026. Over the past year, managed care plans have been working with local agencies to develop strategies to push this initiative forward. We expect the launch of this service to continue through 2025 as plans identify processes and engagement strategies that work for this critical population.
• Behavioral Health Administrative Integration: DHCS requires counties to integrate the administration of specialty mental health and substance use disorder services into a single behavioral health program by January 1, 2027. This is distinct from the CalAIM Full Integration Plan and aims to improve health outcomes and care experiences for Medi-Cal members with co-occurring conditions, by reducing administrative burdens across members, counties, providers, and the state. Behavioral health has continued to be a core focus of CalAIM as well as other national initiatives such as the Integrated Behavioral Health (IBH) Model. Similar to CalAIM, the IBH Model focuses on bringing primary care and behavioral health services together to reduce fragmentation for needed care.

ECM Model Expansion into New Lines of Business – CICM Implementation: California is making a major shift in ECM to better serve dual-eligible (Medi-Cal + Medicare) members, who often have the highest levels of need. By 2026, all health plans in California will be required to offer Dual Eligible Special Needs Plans (D-SNPs), with the implementation of the new California Integrated Care Management (CICM) model. The model focuses on similar vulnerable populations of focus as ECM including adults experiencing homelessness, individuals with substance use disorders or serious mental illnesses, individuals at risk of long-term institutionalization, and others.

The CICM model of care also incorporates several components that build off the ECM model of care. These include face-to-face encounters, the use of a health risk assessment tool, individualized care plans (ICPs), interdisciplinary care teams (ICTs), and established care transition protocols, which all closely align with ECM’s Core Services.

As CalAIM continues, it is advancing beyond initial improvements to shape the future of integrated, equitable care in California. Organizations that proactively invest in care management, data infrastructure, and cross-sector collaboration will be well positioned to succeed in this evolving landscape.

COPE Health Solutions and our team of subject matter experts are well positioned to support organizations as they engage in CalAIM and other noted initiatives across the state. With deep experience in Medi-Cal contracting and care model redesign, we’re ready to help you navigate and prepare for the CICM model and future CalAIM opportunities. Contact us at info@copehealthsolutions.com to learn how we can support your success in California’s evolving Medi-Cal landscape.