California Advancing and Innovating Medi-Cal (CalAIM) is a comprehensive, multi-year initiative launched by the California Department of Health Care Services (DHCS) to transform the Medi-Cal program. The goal is to create a more coordinated, person-centered, and equitable health system for all Californians. CalAIM focuses on improving the quality of life and health outcomes of Medi-Cal enrollees, particularly those with complex health and social needs.
CalAIM introduces several key components to enhance care delivery:
Enhanced Care Management (ECM):
Medi-Cal members with complex needs. A single Lead Care Manager works closely with members to coordinate their health and health-related services, ensuring they receive appropriate care across various settings.
Community Supports (CS):
Also known as In Lieu of Services (ILOS), these are optional services that Medi-Cal managed care plans can offer to address members’ health-related social needs. Community Supports include services like housing transition navigation, recuperative care, and medically tailored meals, aiming to help members live healthier lives and avoid higher levels of care.
Under CalAIM, operators of assisted living and adult residential care facilities have new opportunities to participate in Medi-Cal through ECM and Community Supports. By contracting with managed care plans, these facilities can provide services that support individuals transitioning from nursing facilities to community settings or divert those at risk of institutionalization. This approach expands access to assisted living options and enhances the quality of life for Medi-Cal enrollees.
At Clear Path Care Solutions, we are committed to helping families navigate the complexities of senior care options. With the implementation of CalAIM, there are expanded opportunities to access assisted living and other supportive services through Medi-Cal. Our team can guide you through understanding these new benefits, determining eligibility, and connecting you with facilities that participate in these programs.
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