The California Juggernaut

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

The pending changes to California’s Medicaid program—California Advancing and Innovating Medi-Cal, known as CalAIM—are getting a lot of attention in the health and human service field, but also from the public. For good reason, annual Medicaid spending in California is $26.8 billion, with 15.4 million MediCal members. CalAIM has an expansive scope with many simultaneous initiatives—remaking consumer access and continuity of care in a benefit design that has a mental health carve-out—both Medicaid health plans and county-based mental health plans.

Just in the past six months, there have been an endless number of developments:

• California’s ‘Whole Person Care’ Medicaid Pilot Program Resulted In Fewer Hospitalizations & Emergency Room Visits
• California DHCS Announces New Funding To Help Expand Medication Assisted Treatment For Opioid Addiction In Jails & Drug Courts
• Feds Approve California’s Medicaid Reentry Services Demonstration For People In Jails, Prisons & Youth Correctional Facilities
• Medi-Cal Expands Enhanced Care Management To Long-Term Care Populations
• California To Allow Prison & Jail Inmates To Enroll In Medicaid Up To 90-Days Before Release

• Over 100,000 Medi-Cal Members Receive Alternate Social Support Services Under CalAIM Since January 2022
• Medi-Cal Moves All Dual Eligible Beneficiaries To Managed Care
• California DHCS Launches PATH Initiatives For CalAIM
• California To Apply For 1115 Behavioral Health Community-Based Continuum Demonstration
• California Medicaid Awards Statewide MCO Contracts To Molina, Anthem & Health Net

The pending changes will affect almost every stakeholder in the California service delivery system. According to OPEN MINDS Vice President Richard Louis, some of the biggest changes affecting both specialty provider organizations, community-based organizations (CBO) as well as payers, is the move towards whole person and integrated care models. Medi-Cal managed care plans are now offering Enhanced Care Management and Community Support services targeting the most complex Medi-Cal beneficiaries as the first step. Providers of behavioral health and social services are contracting with the managed care plans to provide these services (adults in 2022 and children/adolescents coming in 2023)—and are challenged to meet new plan requirements.

“These shifts have resulted in a reevaluation of provider organization service lines and operating systems, including the technology required to provide initial client engagement, coordinated care, and performacne reporting under new plan contracts,” said Mr. Louis. “Right now, the transition of county payers and their contract providers from long-standing cost-based reimbursement model to standardized billing using CPT codes has all stakeholders in the California Medi-Cal system scurrying to meet an approaching July 1, 2023 deadline for implementation.” Mr. Louis added, “This being the early stages of the ultimate goal of payer reform which is to achieve a system based on performance and valued based reimbursement by 2027.”