California Advancing and Innovating Medi-Cal (CalAIM)

Anthem Blue Cross (Anthem) is working with the California Department of Health Care Services (DHCS) , county and other local partners to implement the California Advancing and Innovating Medi-Cal (CalAIM) program. CalAIM aims to transform Medi-Cal, making the program more equitable, coordinated, and person-centered to help Anthem members maximize their health and life trajectory. Under CalAIM, Anthem aims to integrate our Medi-Cal Managed Care (Medi-Cal) members’ care across physical health, behavioral health, and local social service providers. CalAIM is for members at all levels of risk and need, while also differentiating and specializing in unmet social needs through Enhanced Care Management (ECM) and Community Supports (CS).

Enhanced Care Management (ECM)

Anthem provides intensive care coordination services at the community level to address physical health, behavioral health, and psycho-social needs.

Enhanced Care Management (ECM) is comprised of seven core services, including:

1. Outreach and engagement.
2. Comprehensive assessment and care management plan.
3. Enhanced coordination of care.
4. Health promotion.
5. Comprehensive transitional care.
6. Member and family supports.
7. Coordination of and referral to community and social support services.

ECM is designed to assist the following populations of focus:¹

• Individuals and families experiencing homelessness
• Individuals at risk for avoidable hospital or emergency department utilization
• Individuals with serious mental health and/or substance use disorder needs
• Adults living in the community and at risk for long-term care institutionalization
• Adult nursing facility residents transitioning to the community
• Individuals transitioning from incarceration²
• Children and youth enrolled in California Children’s Services (CCS) with additional needs beyond the CCS condition
• Children and youth involved in child welfare
• Individuals with intellectual or developmental disabilities (I/DD)
• Birth Equity

To make a referral to Enhanced Care Management or Community Supports, also look for the referral forms on our Forms page.

If interested in joining Anthem’s ECM or CS network, please contact us at CalAIM@anthem.com

If you have questions regarding CalAIM, claims, or billing, please contact us at CalAIM@anthem.com

^{1 Children/youth go live in July 2023, unless otherwise stated.
2 Currently available in Los Angeles County. Expected to go live statewide in 2024.}

Community Supports

Community Supports (CS) are a menu of services, which, at the option of a managed care plan and a member, can substitute for covered Medi-Cal services as cost-effective alternatives. CS providers are entities with experience and expertise providing one or more of the CS to individuals with complex physical, behavioral, developmental, and social needs.

List of Community Supports:

• Housing transition navigation services
• Housing deposits
• Housing tenancy and sustaining
• Short-term post-hospitalization housing
• Recuperative care (medical respite)
• Respite services
• Day habilitation programs
• Nursing facility transition/diversion to assisted living facilities
• Community transition services/NF transition to a home
• Personal care and homemaker services
• Environmental accessibility adaptations (home modifications)
• Meals/medically tailored meals
• Sobering centers
• Asthma remediation

If you have questions surrounding claims and billing, please email CalAIM@anthem.com.

CalAIM Incentive Payment Program (IPP)

Effective as of January 1, 2022, the CalAIM Incentive Payment Program (IPP) is intended to support the implementation and expansion of Enhanced Care Management services and Community Supports by incentivizing managed care plans (MCPs) to:

• Drive MCP delivery system investment
• Bridge the gap between physical and behavioral healthcare service delivery
• Reduce health disparities and promote health equity
• Achieve improvements in quality performance
• Encourage take-up of Community Support

MCPs that elect to participate in the IPP must report on measures in each of these priority areas:

• Delivery system infrastructure
• ECM provider capacity building
• Community Supports provider capacity building and MCP take-up
• Quality measures

Stakeholders interested in applying for IPP funds should visit the CalAIM Incentive Payment Program Initiatives Webpage or email CalAIM@anthem.com to ask your CalAIM IPP related question.

Request for Proposals

This Request for Proposals (RFP) is designed to help Anthem and our plan partner, Santa Clara Family Health Plan, identify and select organizations to engage in an initial 12-month contract to develop and deliver recuperative care services to Medi-Cal members experiencing homelessness.

Recuperative care, also known as medical respite, offers temporary shelter, medical care, behavioral healthcare, and other clinical and social support services to people experiencing homelessness.

After this initial contract term, assuming satisfactory performance, Anthem and Santa Clara Family Health Plan expect to re-contract with chosen organization(s) to provide recuperative care services to Medi-Cal members.

Narrative and gap-filling plans

In 2022, the CalAIM Roundtables provided a stakeholder forum for Medi-Cal Managed Care Plans (MCPs) to identify Enhanced Care Management (ECM) and Community Supports (CS) needs and gaps within the community.

In 2023, DHCS is providing the PATH CPI – Collaborative Planning and Implementation. This is a space for CalAIM stakeholders to network, uplift CalAIM challenges, and identify solutions to contracting and implementation in a supportive space. If you haven’t yet joined the collaborative, go to https://pcgus.jotform.com/222306493964865 .

Community health workers (CHW)

As of July 1, 2022, the Department of Health Care Services added community health worker services as a Medi-Cal benefit. CHWs are trusted community members who help address chronic conditions, preventive healthcare needs and health-related social needs within their communities. CHW services are preventive health services for individuals who need assistance in receiving care to prevent disease, disability, and other health conditions or their progression so to prolong life and promote physical and mental health well-being.

CHW preventive services can be categorized into two groups—health education and health navigation.

Health education: This may include coaching and goal-setting to improve an individual’s health or ability to self-manage health conditions. CHWs will supply information or instruction on topics surrounding:

• Control and prevention of chronic or infectious diseases
• Behavioral health conditions
• Perinatal health conditions
• Sexual and reproductive health
• Environmental health
• Child health and development
• Oral health conditions
• Injury or violence prevention

Health navigation: CHWs will provide information, training, referrals, or support to assist beneficiaries with:

• Accessing healthcare and understanding the healthcare system
• Connecting to community resources, addressing healthcare barriers, or addressing health‑related social needs (in other words, food and nutrition, housing security, economic support, legal services, etc.)
• Serving as a cultural liaison or assisting a licensed healthcare provider to create a care plan
• Screening and assessment that does not require a license
• Connecting to appropriate services to improve their health

For more information on CHW and the services offered, please visit the DHCS Community Health Workers page :

Doula Program

Beginning in 2023, doula services will be available as a preventive service.  Doula services include personal emotional and physical support to women and families from pregnancy experience through childbirth and postpartum. Doulas have been shown to prevent perinatal complications, improve birth outcomes, and reduce health disparities.

Doulas offer various types of support including:

• Perinatal and labor support and guidance
• Health navigation
• Evidence-based education (development of birth plans, linkages to community-based resources, etc.)

Anthem-covered doula services include:

• One initial visit
• Up to eight additional visits that may be provided in any combination of prenatal and postpartum visits
• Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage
• Up to two extended three-hour postpartum visits after the end of a pregnancy

For more information on doula services, please visit the DHCS Doula Services page  and utilize our additional resources.

Doula services resources:

No Wrong Door for Mental Health Services

The DHCS No Wrong Door for Mental Health Services policy sets forth several requirements to ensure members are receiving appropriate mental health services timely and regardless of where they seek care.

Effective as of July 1, 2022, Anthem arranged for eligible members to receive the following non-specialty mental health services (NSMHS):

• Mental health evaluation and treatment, including individual, group, and family psychotherapy
• Psychological and neuropsychological testing, when clinically indicated to evaluate a
  mental health condition
• Outpatient services for purposes of monitoring drug therapy
• Psychiatric consultation
• Outpatient laboratory, drugs, supplies, and supplements*

* This does not include medications covered under the Medi-Cal Rx Contract Drug List.

For more information on the No Wrong Door for Mental Health Services member eligibility and coverage, reach out to your assigned Provider Relationship Management representative or access our No Wrong Door Policy Provider Bulletin .

CalAIM resources