California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year initiative by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of our population by implementing broad delivery system, program and payment reform across the Medi-Cal program. The major components of CalAIM build upon the successful outcomes of various pilots (including but not limited to the Whole Person Care Pilots (WPC), Health Homes Program (HHP), and the Coordinated Care Initiative) from the previous federal waivers and will result in a better quality of life for Medi-Cal members as well as long-term cost savings/avoidance.
CalAIM has three primary goals:
- Identify and manage member risk and need through whole person care approaches and addressing Social Determinants of Health;
- Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
- Improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, and payment reform.
How can I get a letter of support for the upcoming DHCS Medi-Cal Managed Care Plan RFP?
The County will determine the stipulations and process for obtaining the County Letter of Support and is responsible for communicating these requirements to potential Proposers no later than June 1, 2021. Possible items for the county to include in the communication to the MCPs include but are not limited to: key milestone and dates associated with Letter of Support process, how the county will communicate the process to interested parties intending to submit a proposal in response to the MCP RFP, how the interested party will request a county Letter of Support, how the county will determine whether to provide a Letter of Support, conditions under which the county will not provide a Letter of Support, how the county will communicate the response to interested parties, and county point of contact for additional questions or information.
The County of San Diego is carefully reviewing the draft Request for Proposal for Medi-Cal Managed Care Plans posted by the Department of Health Care Services (DHCS) on June 1st and has registered for the June 10th webinar during which DHCS will address key features of the draft RFP and respond to questions that have been submitted.
The Board of Supervisors is planning to discuss this item at the July 13 meeting, where they will establish the Letter of Support (LOS) criteria for requesting and receiving a LOS from the County.
The County will review documents that DHCS will be issuing in early June with final specifications for the new Enhanced Care Management (ECM) benefit and associated In Lieu of Services (ILOS) that are key features of the CalAIM initiative. These specifications will impact the transition of current enrollees in the Whole Person Wellness (WPW) Pilot to ECM/ILOS and many other beneficiaries who receive a variety of County-operated and managed programs.
The County of San Diego is aware of the DHCS June 1st timeline, for counties to communicate the stipulation and process for obtaining a local letter of support for the upcoming DHCS RFP.
The County of San Diego process and stipulation to obtain a letter of support and meet the DHCS June 1st timeline is as follows:
Please see below links to the County Board of Supervisors letter on CalAIM and instructions/guidelines for managed care plans letter of support process.