All About CalAIM
Who is CenCal Health?
CenCal Health is a community-based health plan that administers Medi-Cal benefits in Santa Barbara and San Luis Obispo counties. We partner with a vast network of doctors, hospitals, and other types of providers to deliver healthcare services to over 230,000 Medi-Cal members – about one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County.
Our 2023 – 2025 Strategic Plan
Marking 40 years of serving the most vulnerable on the Central Coast, in 2022, CenCal Health developed a three-year Strategic Plan, outlining future objectives and strategies to support the implementation of California Advancing and Innovating Medi-Cal, commonly referred to as “CalAIM.”
The Strategic Plan is organized around four main priorities – cultivate community partnerships; advance quality and health equity for all; expand our service role and reach; and organize for impact and effectiveness. Tied to each priority are key objectives and multiple strategies to meet CalAIM goals.
To learn more about CenCal Health’s Strategic Plan, click here.
What is CalAIM?
What is CalAIM?
CalAIM is a long-term initiative created by the California Department of Health Care Services (DHCS) to transform and strengthen Medi-Cal. The mission of CalAIM is to offer Californians a more equitable, coordinated, and person-centered approach to maximize their health and life trajectory.
With CalAIM, the holistic health needs of members are prioritized through prevention and whole-person care. Whole-person care means members with complex needs have access to novel services that extend beyond traditional healthcare settings. These services aim to provide comprehensive care and achieve better health outcomes for members whose wellness is impacted by complex social factors, including homelessness, behavioral health, care needs for older adults, transitioning from incarceration, and more.
The factors that contribute to an individual’s health and quality of life are known as social determinants of health (or social drivers of health) and include where people are born, live, learn, work, play, worship, and age, among other life circumstances.
Our Role in CalAIM
As the local Medi-Cal Managed Care plan, CenCal Health is responsible for implementing CalAIM across Santa Barbara and San Luis Obispo counties. To do this, we will work in partnership with our established provider network, county agencies, new safety-net community partners, and other entities that serve our most vulnerable members.
Internally, CenCal Health prioritizes CalAIM considerations in all projects, guided by a 17-member Steering Committee, which has established scope, measures of performance, timelines, and program governance.
New Services Under CalAIM
What are Enhanced Care Management and Community Supports?
Enhanced Care Management and Community Supports are some of the first CalAIM components to go live.
Enhanced Care Management
Enhanced Care Management is a new benefit for members with complex needs requiring seamless coordination between multiple doctors and other care providers.
Enrolled members are assigned a lead care manager who helps coordinate with the member’s doctors, specialists, pharmacists, case managers, and social service providers. The member’s medical care is comprehensively managed, and they receive support to address social determinants of health. Services are delivered through Enhanced Care Management providers contracted with CenCal Health.
DHCS has approved 14 Community Supports to individuals with complex physical behavioral,vdevelopmental, and social needs. These Community Supports are optional services that a managed carevplan like CenCal Health may choose to provide. Community Supports provide cost-effective alternativesvto traditional medical services or settings and may not include direct medical care.
The purpose of Community Supports is to address members with complex social needs, includingvhomelessness, unstable and unsafe housing, and inadequate access to medically appropriate foods. Byvaddressing these social determinants of health, members have a greater opportunity to enjoy healthier lives in a safer environment.
Community-based organizations and providers will typically provide Community Supports services. Enhanced Care Management providers may also serve as Community Supports providers if they have appropriate experience.
As of January 1, 2023, CenCal Health offers six Community Supports services. To learn more about the different services, click here.
Incentive Funding Opportunities Under CalAIM
To support providers and community partners in building, launching, and expanding Enhanced Care Management and Community Supports services, DHCS has made available a provider incentive program, called the Incentive Payment Program (IPP). IPP funds are issued from DHCS to health plans, and from health plans to providers. CenCal Health has IPP incentive funds available for distribution to current and potential Enhanced Care Management and Community Supports providers to support the development and expansion of Enhanced Care Management and Community Supports services.
To learn more about the Incentive Payment Program, click here.
New Programs Under CalAIM
The Housing & Homelessness Incentive Program
The Housing & Homelessness Incentive Program addresses housing insecurity and housing instability as a social determinant of health.
Through the program, Medi-Cal managed care plans, like CenCal Health, may earn incentive funds from DHCS to make investments and progress toward decreasing homelessness and keeping people housed.
CenCal Health submitted a Homelessness Plan to DHCS that demonstrates how the program’s services and supports will be integrated into the local homeless system, in collaboration with our counties, local housing stakeholders, and community partners. As a result of the Plan, CenCal Health secured valuable programmatic funding to implement strategies to decrease and prevent homelessness throughout Santa Barbara and San Luis Obispo counties.
To learn more about the Housing & Homelessness Incentive Program, click here.
The Student Behavioral Health Incentive Program
According to the World Health Organization, over half of all mental health conditions start by the age of 14. With children and youth spending many hours a day in schools, DHCS recognizes that educational settings are a critical point of access to obtain early identification and treatment for behavioral health services.
The Student Behavioral Health Incentive Program is a CalAIM initiative to ensure that every child receives the behavioral health services they are entitled to the first time, and every time, they seek care.
Guided by a comprehensive Needs Assessment Survey, CenCal Health will partner with county offices of education and local educational agencies in Santa Barbara and San Luis Obispo counties to strengthen behavioral health infrastructure in public schools. The targeted program interventions will serve CenCal Health members from transitional kindergarten through 12th grade.