What Is CalAIM?

CalAIM, or California Advancing and Innovating Medi-Cal, is a multiyear process led by the California Department of Health Care Services to improve the health outcomes and quality of life experienced by Medi-Cal enrollees. 

CalAIM is a far-reaching, multi year plan to transform California’s Medi-Cal program and to make it integrate more seamlessly with other social services. Led by California’s Department of Health Care Services, the goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs.

What Are the Goals of the CalAIM Initiative?

• The CalAIM initiative plans to make services more standardized and more equitable across the state, bringing consistency to the current patchwork of programs that vary by county.

• Ensure that the Californians who need the most help and support actually get it — by emphasizing proactive outreach to bring people with complex needs into care and offering a “no wrong door” approach to people seeking help.

• Enable Medi-Cal managed care plans to couple clinical care with a range of new non medical services. Those services, which will be reimbursed by Medi-Cal, include housing supports, medical respite, personal care, medically tailored meals, and peer supports.

• Require plans and incentivize public health systems to be more responsive, equitable, and outcome focused by:

  • Focusing on population health, which involves matching the right patients to the right services at the right time, increasing equity.

  • Implementing payment reform to lay the foundation for paying physical and behavioral health providers based on outcomes rather than services.

  • Ensuring greater accountability for Medi-Cal managed care plans by requiring them to coordinate access to services provided by counties and community-based organizations.

Who Will CalAIM Help?

While CalAIM’s broad reach is intended to help all Medi-Cal enrollees, many of the reforms focus on improving care for people with the most complex needs. This group includes:

• People with significant behavioral health needs, including people with mental illness, serious emotional disturbance, and/or substance use disorder

• Seniors and people living with disabilities

• People experiencing homelessness who also have complex physical or behavioral health needs

• People transitioning from jail or prison back to the community who also have complex physical or behavioral health needs

• Children with complex medical conditions, such as cancer, epilepsy, or congenital heart disease

• Children and youth in foster care

Timeline for CalAIM Implementation

The first CalAIM reforms were implemented in January 2022, and additional reforms will be phased in through 2027. Work is actively underway to ensure a smooth transition from existing programs to CalAIM as reforms are approved.

Sources: CalAIM Explained: A Five-Year Plan to Transform Medi-Cal

How is Exym Behavioral Health EHR Software Preparing for CalAIM?

Exym is focused on continuously learning about CalAIM requirements at both the state and county levels. We ensure our customers have built-in compliance features to ease their transitions and meet deadlines. Visit our new CalAIM Compliance and Support page for the latest up-to-date information on all things related to CalAIM, and our Finance page to view Exym billing features.

Exym is a comprehensive EHR software solution designed specifically for behavioral health agencies. Trusted for 20+ years, our intuitive and customizable software empowers providers to improve client outcomes, manage revenue cycles, and increase agency efficiency. Exym allows you to spend more time on what matters most- the clients in your care.