CalAIM Renewal and 2027 Trailer Bill Provisions
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Proposed amendments to the Welfare and Institutions Code to renew and extend CalAIM, enumerate initiative years through 2031, add a CalAIM 2027 Renewal section (Employment Supports, BridgeCare) with implementation timelines beginning 2027, and require county behavioral health contracting consolidation; affects DHCS, counties, Medi‑Cal managed care plans, behavioral health delivery systems, designated public hospitals, and other CalAIM participants.
Section 14184.900 (CalAIM 2027 Renewal) is added, requiring implementation of Employment Supports and BridgeCare beginning no sooner than January 1, 2027.
Commencing January 1, 2027, counties (or counties acting jointly) must provide and administer covered behavioral health Medi-Cal benefits under a single Medi-Cal behavioral health delivery system contract and, if participating in DMC-ODS, deliver benefits through a single PIHP.
Initiative years 6 through 10 (2027–2031) are explicitly listed as Initiative years 6–10.
CalAIM Terms and Conditions period references updated to show initiative effective period through December 31, 2026 (previously 2031 struck in fragment).
CalAIM 2027 Coverage and Implementation Criteria
CalAIM 2027 coverage and implementation criteria
Coverage stance and implementation criteria introduced or reaffirmed in the proposed trailer bill:
Reimbursement and Effective Date Coding Rules
| Reimbursement rate maintenance and increases required for primary care, obstetric care, and behavioral health service codes as necessary to meet federally imposed minimum requirements specified in the CalAIM Terms and Conditions for dates of service on or after January 1, 2024; applies to fee-for-service claims paid by the department and to claims paid by Medi-Cal managed care plans to the extent required by the CalAIM Terms and Conditions. |
Implementation Authority and County Behavioral Health Contracting
Implementation authority and administrative actions — issue guidance, contract and IT changes, and seek federal approvals
The Department may implement, interpret, or make specific this article or the CalAIM Terms and Conditions by means of all‑county letters, plan letters, provider bulletins, information notices, or other similar instructions without taking any further regulatory action; it must use appropriate processes to ensure affected stakeholders are timely informed and that guidance remains publicly available until all payments related to the applicable CalAIM component are finalized. The Department may enter into or amend exclusive or nonexclusive contracts (bid or negotiated) and implement changes to IT systems for implementation, and those contracts, amendments, and IT changes are exempt from specified provisions of the Government Code, Public Contract Code, and Department of General Services review. Implementation is subject to obtaining any federal approvals the Department deems necessary and availability of federal financial participation; the Department shall report conflicts with the CalAIM Terms and Conditions to the Legislature and may consult stakeholders and submit recommended amendments as described.
- Authority to issue all‑county letters, plan letters, provider bulletins, information notices, or similar instructions without further regulatory action; guidance must remain publicly available until related payments are finalized.
- Permission to enter into or amend contracts and make IT system changes for implementation; such contracts and IT changes are exempt from Chapter 6 of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, Part 2 of Division 2 of the Public Contract Code, and DGS review.
- Must seek necessary federal approvals (including amendments or technical corrections to the CalAIM Terms and Conditions) and implementation is limited to the extent federal approvals and federal financial participation are obtained and not jeopardized.
- Obligation to report conflicts with the CalAIM Terms and Conditions to the Legislature and consult stakeholders; may submit recommended amendments consistent with this article’s goals.
Behavioral health contracting consolidation — single county delivery system contract and single PIHP for DMC‑ODS
Commencing January 1, 2027, an individual county, or counties acting jointly, must provide and administer covered behavioral health Medi‑Cal benefits under a single Medi‑Cal behavioral health delivery system contract and, if participating in DMC‑ODS, must deliver those benefits through a single Prepaid Inpatient Health Plan (PIHP); the Department will conduct planning and issue guidance to facilitate implementation and may authorize eligible noncounty organizations to perform this role under contract.
- Effective date: January 1, 2027 (subject to subdivision (f) of Section 14184.102).
- Requirement applies per county or jointly acting counties; single PIHP required for counties participating in DMC‑ODS.
- Department to conduct necessary planning activities and issue implementation guidance pursuant to Section 14184.102(d).
- Department may authorize noncounty organizations under Sections 14712 or 14124.21 to provide/administer covered behavioral health Medi‑Cal benefits under a single delivery system contract.
Key Definitions (CalAIM, Initiative Years, Contract Terms)
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