CalAIM Resources for Providers

Important Update

Starting January 1, 2024, California Health & Wellness Plan will no longer serve Medi-Cal members. The information and resources provided on this webpage are applicable to services rendered on or before December 31, 2023.

If you are a provider in Amador, Calaveras, Imperial, Inyo, Mono, or Tuolumne counties, who is part of the Health Net provider network starting January 1, 2024, please visit Health Net for services rendered on or after January 1, 2024.

What is CalAIM?

CalAIM (California Advancing and Innovating Medi-Cal) is a multi-year initiative by the California Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Medi-Cal members through broad delivery system, program and payment reform across the Medi-Cal program.

For more information, please visit Health Net's CalAIM Provider Resource page.

CalAIM Billing Information

General

CalAIM Incentives

On January 1, 2022, the California Department of Health Care Services (DHCS) implemented the California Advancing and Innovating Medi-Cal (CalAIM) Incentive Payment Program to support CalAIM initiatives. The California state budget allocated $300 million for incentive payments to Medi-Cal managed care plans (MCPs) for state fiscal year (SFY) 2021-2022, $600 million for SFY 2022-2023 and $600 million for SFY 2023-2024.

Incentive program payments are intended to:

Build appropriate and sustainable Enhanced Care Management (ECM) benefit and Community Support capacity;
Drive MCP investment in necessary delivery system infrastructure;
Incentivize MCP take-up of Community Support;
Bridge current silos across physical and behavioral health delivery;
Reduce health disparities and promote health equity; and
Achieve improvements in quality performance.

The incentive program period is January 1, 2022, to June 30, 2024. The program period will be split between three distinct program years (PYs):

PY 1 (January 1, 2022, to December 31, 2022)
PY 2 (January 1, 2023, to December 31, 2023)
PY 3 (January 1, 2024, to June 30, 2024)

Incentive Payment Documents

Per incentive program requirements, in January 2022, California Health & Wellness Plan (CHWP) submitted Incentive Payment Program Needs Assessment and Gap Filling Plans to DHCS for each of the counties we serve. The Needs Assessment and Gap Filling Plans were developed based on information from CHWP meeting with county and MCP partners, and fielding surveys of contracted ECM and Community Supports providers to identify ECM and Community Supports gaps and needs.

DHCS will use the Incentive Payment Program Needs Assessment and Gap Filling Plans listed below as the basis to determine the allocated incentive dollar proportion that will be paid to CHWP to invest in infrastructure and capacity to support CalAIM objectives.

Incentive Payment Program Needs Assessment

IPP Gap Filling Plans

Incentive Payment Program Year 1 Gap Filling Plans

Going forward, CHWP will use the below process to solicit stakeholder feedback to develop our Incentive Payment Program Needs Assessment and Gap Filling Plans:

Publicly post DHCS-approved Incentive Payment Program Needs Assessment and Gap Fillings Plans to the CHWP website and survey stakeholders to solicit feedback on the DHCS-approved documents.
Solicit feedback from stakeholders on ECM and Community Supports gaps and needs through local level CalAIM roundtables. The CalAIM roundtables will serve as a vehicle for CHWP to engage stakeholders in each county to inform Incentive Payment Program community-wide investments to optimize Incentive Payment Program funding and ensure non-duplicate investments. To learn more about how to participate in a CalAIM roundtable, visit the CalAIM Roundtables website.

Eligible ECM providers can earn incentives through the Plan’s ECM Provider Incentive program when timely outreach and reporting is demonstrated. To learn more, refer to the following communications: