The Board of Supervisors received an update during their previous meeting on implementing California Advancing and Innovating Medi-Cal, or CalAIM, in Yolo County.

CalAIM is a statewide, multi-year initiative by the Department of Healthcare Services (DHCS) to transform and strengthen Medi-Cal by “offering Californians a more equitable, coordinated and person-centered approach to maximize their health and life trajectory,” according to the Yolo County Board of Supervisors’ agenda.

“Because the CalAIM proposals will be implemented over more than five years, Health and Human Services is prioritizing those with the earliest implementation dates,” explained Karleen Jakowski, assistant director of the Health and Human Services Agency. “This creates two key areas of focus, the first is the transformation of the behavioral health delivery system and the implementation of two new medical benefits, enhanced care management and community supports.”

Over five years, CalAIM is set to introduce a myriad of new programs and make important reforms to many existing programs.

“There is no part of Medi-Cal that is untouched by the changes of CalAIM,” she noted.

Jakowski explained to supervisors that CalAIM has three main overarching goals:

• Identify and manage comprehensive needs through whole person care approaches and social drivers of health.

• Improve quality outcomes, reduce health disparities and transform the delivery system through value-based initiatives, modernization, and payment reform.

• Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility.

According to Jakowski, the responsibility to implement these changes is split between the Health and Human Services Agency and the Managed Care Plan providers of each jurisdiction. Partnership HealthPlan of California is the medical managed care provider of Yolo County. During the past 21 months, HHSA has been preparing for CalAIM implementation, both internally and collaboratively, with their partner agencies and Partnership HealthPlan of California.

Partnership has been contracting with local, statewide and even national providers to offer these new services from CalAIM in Yolo County and the other counties they serve

Enhanced care management is a new benefit that provides intensive care management and coordination for those members who have the highest level of need. A number of populations became eligible for this benefit in July 2022, including high utilizers, adults and children experiencing homelessness and those with serious mental illness and substance use disorders. Jakowski explained that other populations that will become eligible this year include those experiencing homelessness, individuals at risk for institutionalization, nursing facility residents transitioning to the community, and children and youth with complex physical, behavioral and/or developmental health needs.

Jakowski also touched on the other new benefit called community supports, which is cost-effective services provided in lieu of more expensive medical covered services.

“This started with six services last year which include housing, transition navigation services, housing deposits, housing tenancy, short-term post-hospitalization housing, recuperative care and medically tailored meals,” Jakowski said. “There are additional services that are coming online in 2023 that include respite services and personal care and homemaker services.”

Yolo County HHSA is responsible for the behavioral health plan changes that includes three main milestones the DHCS expects the county to complete between September 2022 and September 2023. The three main areas of transformation include payment reform, behavioral health policy changes and data exchange.

Mila Green of HHSA, who has been serving as the point person for behavioral health services under CalAIM, explained to supervisors that the county is involved in something called the BHQIP, or quality improvement program, to make these changes.

“The state has allotted Yolo County $880,000 worth of reimbursements should we meet the deliverables along the way and this goes all the way into payments next fiscal year,” Green said.

Jakowski noted that there is still much to do to completely implement CalAIM changes as it is incredibly expansive and complicated. Staff is expected to return to the board with more updates and information at a later date.

“These changes are implemented by a number of factors and there are fiscal drivers to implementing these changes,” Jakowski concluded. “The intent is to make the system easier to navigate and to enhance the benefits that Medi-Cal beneficiaries have access to. There are quality changes that are really at the core of this as well. This is a huge transformation to the system on so many levels and the implementation can be difficult.”