See what’s in the CalAIM waiver proposal
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CalAIM implementers may want to keep a close eye on the work of the Future of Medi-Cal Commission, a 29-member group of health leaders who held their first meeting in January to begin developing a 10-year road map for the Medi-Cal program. Cochaired by Dr. Mark Ghaly, former secretary of CalHHS, and Ann O’Leary, former chief of staff to Gov. Newsom, this initiative has the potential to advance some of the biggest ideas for strengthening CalAIM-type services. The commission will be meeting regularly throughout the year, with the support of a 50-member advisory group and input from Medi-Cal members and the public.
Melora Simon, MPH, Associate Director,
People-Centered Care
The group’s final recommendations are expected to be released in early 2027. Follow this important work by signing up to receive the commission newsletter.
Highlights
The Future of CalAIM: What’s in the new waiver proposal?
DHCS released a proposal for public comment to retain most aspects of the current CalAIM 1115 waiver, either through renewal or by moving initiatives to new authorities.
New report: How street medicine’s powerful model applies to behavioral health
While street medicine has been embraced by managed care plans, a CHCF report highlights ways to further expand this successful model for delivering behavioral health services to unhoused Californians.
Transitional Rent: A guide to navigating a new benefit for eligible Medi-Cal members
A new fact sheet series offers a step-by-step guide to understanding who is eligible for Transitional Rent — and how implementers can ensure qualifying members have access to the housing they need.
The Future of CalAIM: What’s in the new waiver proposal?
In the 1115 waiver proposal released for public comment earlier this month, the California Department of Health Care Services (DHCS) outlines its strategy to continue the transformation of Medi-Cal: renewing existing CalAIM initiatives, transitioning other initiatives to different federal authorities, and seeking authority for new programs.
Proposed for renewal. DHCS seeks to continue 11 existing initiatives, most with no modifications. This includes the Justice-Involved Reentry Initiative (90-day prerelease Medi-Cal services), the DMC-ODS waiver of the Institution for Mental Diseases exclusion for substance use disorder treatment, Recovery Incentives (contingency management for stimulant use disorder), Traditional Healer and Natural Helper services, coverage for out-of-state former foster care youth, chiropractic services from IHS/Tribal facilities, dual-eligible plan alignment, and managed care plan choice limitations in certain counties. Also, DHCS proposes to renew the Global Payment Program with significant modifications to add new services, introduce risk-based funding, and incentivize system transformation.
Transitioning. DHCS plans to move two initiatives to different federal authorities. Community-Based Adult Services would transition to permanent 1915(i) state plan authority. DHCS plans to combine recuperative care with short-term posthospitalization housing in a single new model. This new model of recuperative care would move from 1115 authority, potentially to managed care in-lieu-of-services authority alongside the other Community Supports. The department will seek technical assistance from CMS to identify the best continuation approach, given that CMS has approved recuperative care under various authorities. DHCS also released updated cost-effectiveness data (PDF) for recuperative care that demonstrate a net cost reduction.
New initiatives. Two new county opt-in programs are proposed. Employment Supports would become a benefit to help adults covered under the Medicaid expansion meet new federal work requirements. It also would address barriers to employment, support sustained workforce participation, and promote economic stability among Medi-Cal members. BridgeCare Pilots would offer home and community-based services to "near dual-eligible" older adults (138%–220% FPL) to prevent institutionalization and help them avoid needing Medi-Cal.
Sunsetting initiatives. Finally, DHCS plans to sunset the PATH capacity-building initiative and the Designated State Health Program financing that helped fund it.
This proposal does not include Enhanced Care Management or the remaining Community Supports beyond recuperative care, as they are authorized under the companion CalAIM 1915(b) waiver. DHCS laid out its plans for continuing them in a concept paper (PDF) released last July.
>> Read the full proposal at the DHCS CalAIM 1115 and 1915(b) waiver renewals page — scroll down to “Current Public Comment Opportunities.” While there, you can also register for a public hearing on Tuesday, March 3, 2026, from 11:30 AM to 12:30 PM (PT).
New report: How street medicine’s powerful model applies to behavioral health
Over the last several years, street medicine teams have proven to be one of the most effective ways to deliver integrated primary health care to people experiencing homelessness. Many managed care plans have embraced this approach and now more than half of street medicine teams in the state have clinical contracts with plans (57%), while almost two-thirds have Enhanced Care Management contracts (64%).
More than 80% of unhoused people report experiencing a mental health condition or substance use challenge in their lives, yet less than 25% report receiving treatment. Managed care plan (MCPs), though, only manage the non-specialty side of the state’s behavioral health system. A new CHCF report published last month highlights opportunities for expanding street medicine adoption by both MCPs and the other major entity responsible for providing these services: county behavioral health departments.
While many county behavioral health departments have deep expertise serving unhoused people who need specialty care, the new report identifies several ways street medicine can help further expand their reach — and advance the goals of a range of policies, from CalAIM and No Wrong Door to the Behavioral Health Services Act. The report outlines many steps both MCPs and counties can take to expand street medicine partnerships, from creating reimbursement pathways for field-based care to integrating street team activity into county service delivery.
>> Read the full report, including a practical guide for contracting with street medicine teams, here: Street Medicine: A Critical Pathway for Behavioral Health in California.
Transitional Rent: A guide to navigating a new benefit for eligible Medi-Cal members
Starting on January 1 of this year, managed care plans are now required to provide Transitional Rent, a new benefit that includes up to six months of rental assistance or temporary housing, to members meeting multiple eligibility requirements.
While this is an important step toward improving the health and well-being of Californians experiencing homelessness, the Transitional Rent benefit comes with layers of complexity that make implementation complicated. For starters, this benefit is currently available only to a narrow subset of members who qualify for specialty behavioral health care services, are experiencing or are at risk of homelessness, and also meet specific additional criteria related to unsheltered homelessness, transitioning from an institutional or congregate setting, or eligibility for a comprehensive behavioral health program known as Full Service Partnership.
New tools from Homebase can help CalAIM implementers understand how and whether to request Transitional Rent for Medi-Cal enrollees. Tools include detailed guides for building partnerships and plans to navigate this program. Some of the major issues covered by this new series:
- Eligibility criteria. A step-by-step guide offers detailed explanations of who qualifies for this new benefit.
- Partnerships tool. A detailed checklist helps ensure the right representatives from plans, counties, and other groups are at the table to successfully deliver housing services.
- Housing Support Plan. This fillable form can assist in the development of the Housing Support Plans required for Transitional Rent applications.
- Vignettes. Short stories about Medi-Cal members navigating Transitional Rent that can help partners understand workflows and overcome obstacles.
Other CalAIM Articles and Resources We Recommend
- Conducting a Needs and Assets Assessment for Older Adults Experiencing Homelessness (Community Solutions). Accompanying webinar to be held Friday, March 27, 10 AM (PT). Register now.
- Two-part PATH CPI Sustainability Toolkit designed to strengthen the long-term viability of Enhanced Care Management and Community Supports: Provider and Community. Scroll down in the On-Demand Resource Library. (DHCS PATH)
Webinar: Operationally Sound, Financially Secure: A CalAIM Playbook for Health Centers (Primary Care Development Corporation), Tuesday, March 3, 2026, 11 AM (PT)
Webinar: Making CalAIM Work for Community Providers (First 5 Leadership Institute), Thursday, March 26, 10 AM (PT)
