Close Look at Homelessness
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Michelle Schneidermann, MD, Director,
People-Centered Care
The evidence has been mounting for years: For people experiencing homelessness, safe, affordable housing is health care. That was the focus of a CHCF briefing in Sacramento earlier this month. It’s also the theme of this month’s digest, where we’re taking a closer look at how CalAIM’s trio of housing supports are helping providers build partnerships across the health, homelessness, and housing sectors — and improve care for Californians experiencing homelessness. If you missed the briefing, no worries — just visit our website to watch a recording and see our fact sheets and other resources.
Highlights
Feds rescinded the guidance that helped California create CalAIM — what it means
In early March, the federal government signaled a change in direction when it comes to using Medicaid funding to address health-related social needs. However, existing approvals — including those authorizing CalAIM's Enhanced Care Management and Community Supports — will continue without disruption.
When the whole is greater than the sum of the parts: CalAIM plus the Housing and Homelessness Incentive Program
An in-depth analysis of two important initiatives shows the difference they are making in facilitating partnerships and collaboration between local homeless response systems and managed care plans.
Affordable housing workgroup offers unique opportunity to pair housing, CalAIM supports
CHCF has partnered with UC Berkeley’s Terner Center for Housing Innovation to work with a group of affordable housing providers on how CalAIM can help them keep residents housed.
Feds rescinded the guidance that helped California create CalAIM — what this means
Earlier this month the US Centers for Medicare & Medicaid Services (CMS) rescinded guidance on health-related social needs. The guidance had created pathways for more states to incorporate housing, nutrition, and other social services into their Medicaid programs, building on California’s example.
Please know that the CalAIM program stands. CMS has confirmed that existing approvals — including the waivers that authorize CalAIM's Community Supports — are unaffected by the policy change. This means that ECM, and all the Medi-Cal Community Supports, including the housing supports, will continue without disruption through the existing waivers.
California’s approach to health-related social needs crosses two different Medicaid waivers. If you are curious about how these waivers work or want to understand the role of the federal government in Medi-Cal financing, please see CHCF’s new set of fact sheets.
In addition, CHCF recognizes that the federal government is considering major changes to the Medicaid budget as well as to the regulations and rules governing the program. We are collecting and publishing resources to help advocates, policymakers, health care leaders, and other partners understand the current Medi-Cal program and to stay abreast of new federal policies under debate and their potential impact on California.
>> See the new fact sheets on the CHCF website about Medicaid waivers and State Plan Amendments, written by Aurrera Health Group. Visit CHCF’s website section Defending Medi-Cal in 2025.
When the whole is greater than the sum of the parts: CalAIM plus the Housing and Homelessness Incentive Program
Improving health outcomes for people with complex needs who are unhoused remains one of California’s toughest challenges. But it’s clear we are making progress. The Housing and Homelessness Incentive Program (HHIP), alongside CalAIM's housing-related Community Supports and Enhanced Care Management, are transforming how health and homelessness systems collaborate to support Californians experiencing homelessness.
HHIP’s onetime funding incentivized meaningful partnerships between managed care plans and homeless response systems. Together with CalAIM’s ongoing funding for housing services through the managed care plans, HHIP has catalyzed significant systems change. A recent analysis of these two initiatives (PDF) by Homebase highlights key successes, including these:
- Managed care plans establishing deeper integration with homeless service providers
- Flexible HHIP funding enabling communities to quickly address emerging needs
- Enhanced Care Management providing comprehensive support to members where they are — whether in shelters, encampments, or homes
See how these cross-sector partnerships are playing out locally in four on-the-ground case studies (PDF): Alameda, Fresno/Madera, Los Angeles, and Santa Barbara.
Although implementation challenges exist, particularly around cross-system coordination and data sharing, these initiatives demonstrate the progress and momentum achieved over the past few years. Indeed, a new analysis of CHCF’s statewide CalAIM implementer survey looking only at providers serving people experiencing homelessness shows that more than two-thirds of respondents report improvements in the experience of care for unhoused people under CalAIM, with even higher numbers in rural areas.
>> Homebase’s in-depth look at HHIP and CalAIM implementation, as well as the four case studies, can be found on the Homebase website. See CHCF’s survey of homeless service providers’ perspective on CalAIM.
Affordable housing workgroup offers unique opportunity to pair housing and CalAIM supports
A growing number of affordable projects are being built to help unhoused people get off the street. These permanent supportive housing (PSH) properties pair safe housing with services that help address residents’ chronic medical or behavioral health conditions.
Many PSH properties have a better than 90% success rate helping residents avoid returning to homelessness. Like so many other successful programs, though, providers lack access to steady funding sources to maintain these services — a problem CalAIM may be well-positioned to address.
To help raise awareness about CalAIM’s trio of housing supports, CHCF has partnered with the Terner Center for Housing Innovation at UC Berkeley to convene a group of housing providers interested in learning how the program can help them keep their residents housed.
“I have talked to many PSH residents who say it has transformed their health and stabilized their families. That’s why we want to connect CalAIM with PSH services — because it works,” says Carolina Reid, PhD, faculty research adviser at Terner, in a recent Q&A about the new workgroup. “Although there’s a lot of uncertainty and risk for a developer in counting on Medi-Cal funding to provide supportive services, developers are investing a lot of energy into figuring out these challenges because of the tremendous potential benefits of providing person-centered care.”
>> Read the full interview with Carolina Reid from the Terner Center in this CHCF Q&A: Housing Developers Leverage CalAIM for People Experiencing Homelessness. More information about the workgroup and its members is available on the CHCF website: Bridging the Gap: Aligning Supportive Housing and Health Care Under CalAIM.
Other CalAIM Articles and Resources We Recommend
- Moving with Medi-Cal: A Guide to Inter-County Transfers (Homebase)
- Medicaid Spending Curbed by North Carolina Program Addressing Social Determinants of Health (Modern Healthcare Executive)
- At the Intersection: Child Welfare and Enhanced Care Management — Tapping the Potential to Support Families (PDF) (Full Circle Health Network)
- Enhancing Financial Sustainability for Street Medicine: Examining Medi-Cal Managed Care Contracts with California Providers (California Health Policy Strategies)
- The 2025-26 Budget: CalAIM Enhanced Care Management and Community Supports Implementation Update (Legislative Analyst’s Office)
- They Live in California’s Republican Districts. They Feel Betrayed by Looming Health Care Cuts (CalMatters)
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