Overview of Medi-Cal Reforms Impacting Managed Care Plans: California Advancing and Innovating Medi-Cal (Cal-AIM)

MCPs can provide a variety of services and supports that benefit the mental, physical, and environmental health of foster youth and their families/caregivers.

The California Advancing and Innovating Medi-Cal (CalAIM) and Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT), creates new benefits and services, and streamlines processes with child welfare agencies (CWAs), through Medi-Cal Managed Care Plans (MCPs), County Mental Health Plans (MHPs), and Non-Specialty and Specialty Mental Health Services.

MCPs can provide a variety of services and supports that can benefit the mental, physical, and environmental health of foster youth, such as:

• Community Supports: Services that help improve Medi-Cal MCP members’ overall health by addressing needs like housing, meals, and personal care. View the fact sheet for a list of the supports: Community Supports Fact Sheet. The availability of each support is dependent on each county and can vary.
• Behavioral Health: Component of this include peer support services, CalAIM behavioral health trainings, behavioral health quality improvement program, California contingency management benefits, and Department of Health and Human Services (DHCS) behavioral health reporting. To read additional information on the Cal-AIM reform that specifically impacts foster youth such as medical necessity, No Wrong Door, Screening and Transition Tools and Medi-Cal for Kids and Teens go to Foster Youth Mental Health.
• Dental: CalAIM aligns Medi-Cal policies with national dental care standards to improve amount of children/youth receiving their annual dental checkup, and increase the overall use of dental benefits among all Medi-Cal members.
• Population Health Management (PHM): Ensures Medi-Cal members have access to a comprehensive program that leads to improved health outcomes and health equity. Under PHM, MCPs and their partners are responsive to individual member needs within the communities they serve while working within a common framework and set of expectations.

The CalAIM: Population Health Management (PHM) Policy Guide outlines these programs in further detail.

These Population Health Management programs impact foster youth:

• Basic Population Health Management (BPHM): BPHM is the basic set of services and supports to which all populations have access regardless of their risk tier. BPHM includes access to primary care, care coordination, navigation of referrals across health and social services, services provided by Community Health Workers (CHWs) under the new CHW benefit, wellness and prevention programs, chronic disease programs, and case management services for children via the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. CHWs may be able to address a variety of health and health-related issues, including, but not limited to: supporting members’ engagement with their Primary Care Provider, identifying and connecting members to services that address social driver of health needs, promoting wellness and prevention, helping members manage their chronic disease, and supporting efforts to improve children health.
• Complex Care Management (CCM): CCM is a care management service for children and youth who need extra support to avoid adverse outcomes but who are not in the highest risk group designated for ECM. CCM can provide qualifying children and youth both episodic services or ongoing chronic care coordination and must include a comprehensive assessment of each members’ condition, available benefits and resources, development and implementation of a Care Management Plan, and assignment of a CCM Care Manager. CCM Care Managers conducts assessments of members’ needs to identify and close any gaps in care and complete case management plans for all members receiving CCM. MCPs should provide assistance with navigation and referrals, such as to CHWs, county First 5s, and/or community-based social services. CCM is administered by Medi-Cal MCPs, and a member’s MCP can be contacted for additional details.
• Enhanced Care Management for Children and Youth (ECM): Children and youth in Child Welfare are one of the Populations of Focus that are eligible for ECM. ECM is intended to identify and close gaps in needed services, as well as ensure whole-person care coordination occurs between a child’s or youth’s medical care, behavioral health care, and social services delivery systems. This includes tribal children and youth that meet the Populations of Focus requirements. An ECM Lead Care Manager is responsible for whole-child care coordination between all participants in the care plan for a youth involved in child welfare.

Eligibility:

• Are under age 21 and are currently receiving foster care in California or
• Are under age 21 and previously received foster care in California or another state within the last 12 months or
• Have aged out of foster care up to age 26 (having been in foster care on their 18th birthday or later) in California or another state or
• Are under age 18 and are eligible for and/or in California’s Adoption Assistance Program or
• Are under age 18 and are currently receiving or have received services from California’s Family Maintenance program within the last 12 months.
• Eligible Members may be referred to the Medi-Cal MCP ECM program by a provider, case manager, other professional already serving the child or youth, or through self-referral by caregivers. Each MCP maintains an ECM website with referral instructions.