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December 31, 2021

CMS Approves California Advancing & Innovating Medi-Cal (CalAIM) Waivers, Including Provisions to Address Social Determinants of Health

In December, CMS approved some of California’s CalAim proposals through extensions of its 1115 demonstration and 1915(b) managed care waivers. California is transitioning significant programs under its prior 1115 waiver into its 1915(b) waiver, and working to sustain support for a whole-person care approach, including through a package of innovative programs to address the physical, behavioral, and health-related social needs of the state’s most vulnerable populations. Such programs include authorization of managed care plan coverage of Community Support services “in lieu of” alternative services or settings covered under the state plan as well as coverage of additional Community Supports through 1115 demonstration authority (recuperative care and short-term post-hospitalization services). The 1115 waiver renewal also continues the Global Payment Program (GPP), which encourages primary and preventive care for the remaining uninsured, and a Providing Access and Transforming Health (PATH) program to support capacity-building for providers and community based organizations to implement the new services under CalAIM, although CMS has not yet approved requests for federal funding of Designated State Health Program (DSHPs) to support the on-federal share funding for the PATH program.

See the 1115 demonstration and 1915(b) approvals for additional information.