What CalAIM Means for You and Your Family

Most California families have heard the word "CalAIM" without knowing what it actually delivers. CalAIM, California Advancing and Innovating Medi-Cal, is the most consequential restructuring of the state's Medicaid program since the 2014 Affordable Care Act expansion. It is not a single benefit, not a single waiver, and not a separate insurance card. It is a five-year federal-state demonstration project that runs January 1, 2022 through December 31, 2026, financed in large part by California's Managed Care Organization (MCO) tax, executed through the Medi-Cal Managed Care plan that already serves your loved one. As of 2026, CalAIM has produced two flagship statewide benefits, Enhanced Care Management (ECM) and Community Supports (CS), plus the country's first §1115 Justice-Involved Pre-Release Medicaid coverage, the country's first §1115 Transitional Rent benefit, an integrated behavioral-health expansion called BH-CONNECT, and a statewide Population Health Management infrastructure that ties them together. If your family member is hospitalized, transitioning out of a nursing facility, recovering from a behavioral-health crisis, or living independently with mounting fall risk and food insecurity, the question is no longer whether CalAIM benefits exist. The question is whether your Medi-Cal plan has elected to offer them in your county, and whether your discharge planner, clinic, or care manager knows how to refer you. This guide explains, in plain language, what CalAIM is, what it covers in 2026, the 14 (now 15) Community Supports, the Enhanced Care Management benefit, the Justice-Involved Pre-Release framework, what is changing under the 2027-2031 renewal application now pending at CMS, and exactly how an older Californian or family caregiver can request the right benefit from the right place.

The 60-second version

If you read nothing else, take this with you:

1. CalAIM is a §1115 Medicaid demonstration, federally approved December 29, 2021 (Demonstration No. 11-W-00193/9) with a five-year term running January 1, 2022 through December 31, 2026. CMS approval is pending for a renewal cycle running January 1, 2027 through December 31, 2031.
2. It is delivered through your Medi-Cal Managed Care plan (MCP), Anthem, Health Net, Molina, Blue Shield Promise, Kaiser, L.A. Care, Inland Empire Health Plan, Partnership HealthPlan, CalOptima, the Local Health Plan of San Mateo, and dozens of others. CalAIM benefits are not available to fee-for-service Medi-Cal members.
3. Two flagship benefits anchor it. Enhanced Care Management (ECM) is intensive in-person care coordination for high-need members. Community Supports (CS) are 14, now 15 with Transitional Rent, pre-approved alternative services your plan may offer in lieu of traditional Medi-Cal benefits.
4. Community Supports include Recuperative Care (medical respite), Medically Tailored Meals, Housing Transition Navigation, Housing Deposits, Housing Tenancy & Sustaining, Short-Term Post-Hospitalization Housing, Nursing Facility Transition/Diversion to Assisted Living, Community Transition Services, Personal Care & Homemaker Services, Home Modifications (Environmental Accessibility Adaptations), Sobering Centers, Asthma Remediation, Day Habilitation, and Respite Services. Plus the new Transitional Rent benefit.
5. CS are NOT entitlements. Each MCP elects which CS to offer in its service area. The average plan offered 8 of 14 in late 2025; L.A. Care offered 14; the lowest-offering plan offered just 4. Your menu depends on your plan and your county.
6. ECM is NOT direct service delivery. A Lead Care Manager coordinates your care, builds an Individualized Care Plan, and connects you to medical providers, IHSS, behavioral health, and Community Supports. They do not provide medical care or personal care themselves.
7. Justice-Involved Pre-Release coverage, the first §1115 of its kind in the United States, provides limited Medi-Cal services to incarcerated Californians during the 90 days before release. It is a county-by-county rollout; about 38 of 58 counties were live as of April 2026.
8. Transitional Rent is the first federal Medicaid benefit in U.S. history to authorize direct rent payment. CMS approved California's expenditure authority in December 2024; APL 24-029 made it operational January 1, 2025; statewide expansion arrived January 1, 2026. Up to six months of rent for ECM-enrolled members.
9. For older adults, the most accessible CalAIM benefits are Recuperative Care after a hospital stay, Medically Tailored Meals for chronic disease, Environmental Accessibility Adaptations for home modifications, Personal Care & Homemaker Services as IHSS gap-fill, the NF-to-Community pathway, and Respite Services for unpaid family caregivers.
10. Your escalation path is your MCP member services line first. If your plan does not respond, call DHCS Office of the Ombudsman at 1-888-452-8609.

This guide unpacks each of these points and shows you exactly how to access them.

What CalAIM is, and what it isn't

CalAIM is a layered legal construct. Understanding it requires distinguishing four kinds of authority operating concurrently. The §1115(a) demonstration waiver, codified at 42 U.S.C. § 1315, gives California permission from the federal Centers for Medicare & Medicaid Services (CMS) to test new ways of delivering Medicaid that would not otherwise be allowed. The §1915(b) managed-care waiver, codified at 42 U.S.C. § 1396n(b), authorizes the basic structure of mandatory managed care, the County Mental Health Plan delivery system, and selective contracting. State Plan Amendments and §1915(c) HCBS waivers, including HCBA, ALW, MSSP, the HCBS-DD waiver, CBAS, IHSS, and PACE, operate in parallel and are aligned with but not subsumed by CalAIM. And finally, the California legislature passed a series of trailer bills, AB 133 (2021, Chapter 143, the omnibus health trailer bill that amended Welfare and Institutions Code §§14184.100-14184.402), AB 102 (2021), SB 184 (2022), SB 132 (2023, the MCO Tax reauthorization), SB 136 (2024), and AB 116 (2025), that carry the state-side appropriations and statutory framework.

What CalAIM did NOT do is replace California's HCBS waivers. The §1915(c) waivers, HCBA, ALW, MSSP, the HCBS-DD waiver, continue to operate under their independent federal authority, with their own waitlists, eligibility rules, and service packages. CalAIM Community Supports include some HCBS-style services but they are managed-care plan benefits offered at the MCP's discretion, not waiver entitlements. If your loved one is on the HCBA waiver waitlist or enrolled in MSSP, those benefits remain unchanged by CalAIM.

CalAIM also did not unify behavioral health. California's three-tier behavioral health structure, Medi-Cal Managed Care plans for mild-to-moderate mental health and certain substance use disorder services; County Mental Health Plans for Specialty Mental Health Services under §1915(b); and Drug Medi-Cal Organized Delivery System (DMC-ODS) counties for substance use disorder treatment, remains. CalAIM did add the "No Wrong Door" referral framework (APL 22-005), the BH-CONNECT demonstration component, and several behavioral-health quality initiatives, all detailed below.

What CalAIM did do, and what makes it consequential, is consolidate three earlier pilots, Whole Person Care (25 county-led pilots 2016-2021), the Health Homes Program (§1945, 2018-2021), and DMC-ODS, into the statewide ECM benefit; create the federally permitted Community Supports menu; carve historic services like Community-Based Adult Services and long-term care nursing facility benefits into managed care; establish the Justice-Involved Pre-Release framework; and lay the financial and analytic groundwork for population health management at scale. Roughly 14.1 million Californians are enrolled in a Medi-Cal Managed Care plan in 2026, about 14 of every 15 Medi-Cal members. That is the population that can receive CalAIM benefits.

Demonstration timeline at a glance

CMS approval for CalAIM came in a letter dated December 29, 2021, addressed to the DHCS Director (then Will Lightbourne), accompanied by Special Terms and Conditions running approximately 280 pages. Each calendar year inside the demonstration is a Demonstration Year (DY). DY 17 was 2022 (CalAIM continued the §1115 numbering established with the Bridge to Reform 2010 demonstration and Medi-Cal 2020). DY 21 is the current 2026 year. Under the renewal application submitted to CMS February 10, 2026, with the federal public-comment period closing March 12, 2026, DY 22 begins January 1, 2027 and DY 26 ends December 31, 2031. CMS approval is anticipated late December 2026, with extension authority available if final approval slips into early 2027.

Seven amendments to the original demonstration matter for this guide. Amendment 4, approved by CMS January 26, 2023, authorized the country's first §1115 Justice-Involved Pre-Release Medicaid benefit. Amendment 5, approved December 2023, established BH-CONNECT, effective January 1, 2025. Amendment 6, approved December 2024, authorized the Transitional Rent Community Support, making California the first state with §1115 expenditure authority for direct rent payment. Amendments 1, 2, 3, and 7 covered ECM provider clarifications, Tribal coverage, Whole Person Care and Health Homes Program closeout, and Continuous Eligibility for Children.

The 14 Community Supports (and the 15th)

Community Supports, formerly called In Lieu of Services, are pre-approved cost-effective alternative services authorized by 42 C.F.R. § 438.3(e)(2). The federal regulation allows a managed-care plan to substitute a service that is medically appropriate and cost-effective for a covered State Plan service, as long as the substitution is voluntary on the member's part. Each CS has DHCS-published parameters and an All Plan Letter (APL) authority, primarily APL 23-026 ("In Lieu of Services and Settings: Community Supports"), with APL 24-013 (Matching Plan Policy) and APL 24-029 (Transitional Rent) layering more recent guidance.

Critically, CS are NOT entitlements. Your MCP elects which CS to offer in its service area, subject to DHCS approval. The MCP also sets eligibility criteria within DHCS-published parameters and applies medical-necessity-style review. A member who needs a CS not offered by their MCP is not entitled to receive it. They may, however, request a continuity-of-care exception or a plan change.

The 14 Community Supports approved as of 2026:

The single most important fact about CS for a Brevy reader is this: which CS are available depends entirely on your MCP and your county. A Medi-Cal member in Los Angeles whose MCP is L.A. Care has access to all 14 CS plus Transitional Rent. The same member in a rural county under a different MCP may have access to only four or five. DHCS publishes a quarterly Community Supports adoption dashboard that shows which CS each MCP has elected. Before you assume a benefit is unavailable, call your MCP member services line and ask explicitly: "Does this plan offer the [Recuperative Care / Medically Tailored Meals / Environmental Accessibility Adaptations] Community Support in my county? If yes, how do I refer?"

DHCS' renewal concept paper proposes a "core menu" of CS that all plans would be required to offer beginning in 2027, Recuperative Care, Housing Navigation, Housing Tenancy & Sustaining, Medically Tailored Meals, NF-to-Community Transition, and Asthma Remediation. CMS has not approved this requirement as of publication.

Enhanced Care Management, the high-touch coordination benefit

ECM is California's universal Medi-Cal Managed Care benefit for high-need members. Conceptually, it is in-person, intensive, whole-person care coordination delivered by an ECM Provider (typically a community-based organization, FQHC, RHC, county behavioral health agency, IHS/Tribal 638 facility, hospital with limited scope, CBAS provider, or IHSS County Public Authority) under contract with your MCP. The MCP receives a per-member-per-month (PMPM) capitation rate from DHCS for ECM-enrolled members and pays the ECM Provider on a PMPM basis, typical rates run $400 to $800 PMPM in 2026 dollars depending on Population of Focus and acuity tier.

ECM consolidated two earlier pilots: Whole Person Care (25 county-led pilots 2016-2021), and the Health Homes Program (the §1945 health-home benefit California operated 2018-2021). Members enrolled in WPC or HHP transitioned to ECM as their MCPs began offering it in 2022.

The original 9 Populations of Focus (2022-2025)

Through 2024 and 2025, ECM operated with nine canonical Populations of Focus:

1. Adults experiencing homelessness
2. Adults at risk of avoidable hospital or emergency department utilization (formerly "high utilizers")
3. Adults with serious mental illness OR substance use disorder
4. Adults transitioning from incarceration
5. Adult Nursing Facility residents transitioning to community
6. Children/youth experiencing homelessness
7. Children/youth at risk of avoidable hospital or ED
8. Children/youth with SMI/SUD or serious emotional disturbance
9. Children/youth involved in child welfare

The updated 10 POF categories (2026)

DHCS published a revised ECM Policy Guide effective January 2026 that consolidated and expanded the POF list. The 2026 categories:

1. Individuals/families experiencing homelessness
2. Individuals at risk for avoidable hospital or ED utilization
3. Adults with serious mental illness or substance use disorder
4. Children/youth with serious emotional disturbance, substance use disorder, or other complex behavioral health needs
5. Adults living in the community at risk for institutionalization
6. Adult Nursing Facility residents transitioning to community
7. Adults and youth transitioning from incarceration
8. Birth Equity Population of Focus (added 1/1/2025)
9. Children/youth in California Children's Services with additional needs
10. Children/youth and adults with intellectual or developmental disabilities (IDD) who also meet another POF need

ECM enrollment has grown substantially since launch: roughly 108,000 unduplicated members in 2022; 190,000 in 2023; 270,000 in 2024; 340,000 in 2025; and a projected 395,000 in 2026. The dominant POFs by enrollment volume are at-risk-for-avoidable-utilization adults, adults experiencing homelessness, and adults with SMI/SUD. The adult Nursing Facility transition POF, the category that should reach the largest share of older adults living in nursing facilities, is dramatically underutilized at fewer than 15,000 unique members per year, far below DHCS' modeled potential. This is the principal advocacy push under the renewal application: getting more older adults out of nursing facilities and back to the community via ECM coordination.

What an ECM member experiences

If a member is identified as ECM-eligible, the ECM Provider offers an in-person introductory visit, assigns a Lead Care Manager, develops an Individualized Care Plan, and conducts ongoing in-person and telephone contact (typically a monthly minimum). The Lead Care Manager arranges warm hand-offs to specialty providers, coordinates transportation, helps manage prescriptions, supports post-hospital and post-jail transitions, and connects the member to applicable Community Supports. ECM is voluntary, members may decline ECM, and may disenroll at any time.

ECM is NOT direct service delivery. The Lead Care Manager does not provide medical care and does not perform IHSS personal-care tasks. The ECM Provider coordinates and connects; the medical provider treats; the IHSS provider provides personal care.

For older adults specifically, the most operationally important interaction is between ECM and IHSS. An ECM Lead Care Manager can help an eligible older adult apply for IHSS, navigate the county IHSS assessment, advocate for adequate hours, and re-engage if hours are reduced. ECM does not authorize IHSS hours, only the County IHSS Social Worker does that, but ECM is a documented success channel for under-served IHSS applicants. Information Notice 24-014 codifies the ECM-IHSS coordination protocol.

Justice-Involved Pre-Release Medi-Cal

The Social Security Act §1905(a)(31)(A), the "Inmate Exclusion", has historically barred Medicaid coverage for inmates of public institutions. The result was a re-entry "cliff" at the moment of release: individuals lost Medicaid coverage during incarceration and faced a 30-90 day gap before restoration, increasing post-release mortality, hospitalization, and substance-use overdose by orders of magnitude.

CalAIM Amendment 4, applied for in 2022 and approved by CMS January 26, 2023, authorized federal financial participation for a defined Medi-Cal benefit package delivered to incarcerated individuals during the 90 days immediately before release. California was the first state in the nation to receive this authority. CMS subsequently issued State Medicaid Director Letter SMD 23-003 (April 17, 2023) establishing a national framework, and a growing list of states, Washington, Massachusetts, Montana, Oregon, Vermont, and others, have followed.

What is covered

The pre-release benefit package includes care management for the impending release transition; physical and behavioral-health clinical consultation including telehealth linkage to community-based clinicians who will assume care upon release; laboratory and radiology services with linkage to community primary care; Medication-Assisted Treatment for opioid use disorder, alcohol use disorder, and tobacco cessation (including initiation of buprenorphine, methadone, naltrexone); Community Health Worker peer-support services; medications and durable medical equipment delivered with the individual on the day of release, including a 30-day prescription supply; and hospital transitions for individuals released to or from inpatient hospitalization.

Who qualifies

To receive pre-release services the incarcerated individual must be Medi-Cal enrolled or eligible AND within 90 days of expected release AND meet at least one of eight clinical-eligibility criteria: mental health diagnosis, substance use disorder, chronic clinical condition requiring care management, significant non-chronic clinical condition, traumatic brain injury, intellectual or developmental disability, HIV/AIDS, or pregnancy/postpartum within 12 months. Many inmates do not qualify, a frequent misunderstanding worth explicit attention.

The county-by-county rollout

Because California's correctional system is decentralized, 35 California Department of Corrections and Rehabilitation state prisons plus 58 county jail systems plus several federal facilities plus tribal corrections, implementation is rolling. The first county/facility went live October 1, 2024 (Inyo County jail). Subsequent waves include Santa Clara, Yuba, San Diego, Los Angeles, and CDCR state facilities. As of April 2026, approximately 38 of 58 counties were live, 12 in active implementation, and 8 in early planning.

Post-release, individuals exiting incarceration with qualifying conditions are auto-enrolled in ECM under the "Adults Transitioning from Incarceration" Population of Focus. The MCP's ECM Provider receives the individual's transition file and engages within 14 days of release.

The 2027-2031 renewal application proposes extending pre-release coverage from 90 days to 120 days for individuals with the most complex needs and extending coverage to community-supervision (probation and parole) populations.

Behavioral health under CalAIM, BH-CONNECT, DMC-ODS, and No Wrong Door

CalAIM did not unify behavioral health. California still operates the historic three-tier structure: Medi-Cal Managed Care plans for mild-to-moderate mental health and certain substance use disorder services; 58 County Mental Health Plans (MHPs) for Specialty Mental Health Services under §1915(b); and DMC-ODS counties for substance use disorder treatment under §1915(b). What CalAIM added was the No Wrong Door framework, BH-CONNECT, and several quality and incentive programs.

Under APL 22-005 and Information Notice 22-011, members can access mental health services by presenting at either their MCP or their County MHP. The receiving system must initiate appropriate referrals, may not deny services pending an SMHS-criteria determination, and must facilitate bidirectional referrals when the appropriate level of care changes.

The Specialty Mental Health Services access criteria moved from a long-standing "medical necessity for SMHS" framework to a clinical-need-based framework that emphasizes clinical impairment and likely benefit from treatment. The most recent guidance, BHIN 26-002 effective January 20, 2026, superseding BHIN 21-073, codifies the new criteria.

DMC-ODS is California's §1915(b) opt-in delivery system for substance use disorder services. Counties that opt in operate the full ASAM (American Society of Addiction Medicine) continuum: Level 0.5 early intervention through Level 4 medically managed inpatient, plus Withdrawal Management, Opioid Treatment Programs, Medication-Assisted Treatment, Recovery Services, Case Management, and Physician Consultation. As of January 2026, 40 of 58 counties participate in DMC-ODS, covering roughly 95% of California's population. Counties currently outside DMC-ODS are mostly small rural counties (Alpine, Sierra, Modoc, etc.).

BH-CONNECT, the §1115 behavioral-health expansion

BH-CONNECT (Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment) is a §1115 demonstration component approved by CMS in December 2023 with an effective date of January 1, 2025. It authorizes:

• IMD authority, federal Medicaid match for short-term Institution for Mental Disease stays (≤60-day average length of stay; specific facility size/certification requirements). This overcomes the historic "IMD exclusion" under §1905(a)(B), which barred Medicaid payment for inpatient psychiatric care in facilities of more than 16 beds. A meaningful expansion of acute psychiatric capacity.
• New behavioral-health service authorities, Clubhouse services, Community-Based Mobile Crisis Intervention Services, expanded Peer Support Services, Supported Employment via the Individual Placement and Support (IPS) model.
• Capacity-building grants for behavioral-health providers, similar to the PATH grants for ECM and CS providers.

DHCS APL 25-007 operationalizes BH-CONNECT.

Proposition 1 / Behavioral Health Services Act

In March 2024, California voters approved Proposition 1, restructuring the existing Mental Health Services Act (the "millionaire's tax" enacted by Proposition 63 in 2004) into the Behavioral Health Services Act (BHSA) and authorizing $6.4 billion in housing-and-treatment bond financing. Counties must fully implement Prop 1 program changes by July 1, 2026. Beginning that date, counties must offer IPS Supported Employment under BHSA. BHSA is not technically a CalAIM component, but it operationally aligns with BH-CONNECT and ECM for adults with serious mental illness.

Population Health Management, the analytic spine

DHCS published its Population Health Management strategy in 2022 (Information Notice 22-058) and operationalized the PHM Service in 2024, with continued build-out through 2026. PHM is the analytic and care-coordination layer that sits above ECM, CS, and standard MCP services. Its goals: identify members at rising risk of poor health outcomes; segment members into four tiers (Low-Risk Wellness, Rising Risk, High Risk for ECM consideration, Complex/Whole-Person ECM full enrollment); and ensure that the right services reach the right members through standardized care-coordination protocols.

The PHM Data Hub ingests claims, eligibility, encounter, and demographic data across MCPs, the County MHP system, IHSS, regional centers, and the State Plan, applies stratification logic, and pushes member-level risk segmentation outputs to MCPs. It is the technical infrastructure that allows DHCS to coordinate care across what were previously siloed systems.

How CalAIM is paid for, the MCO Tax

The Managed Care Organization Tax is the single largest financing source for CalAIM-era investments. SB 132 (2023, Chapter 13) reauthorized the MCO tax effective April 1, 2023 through December 31, 2026, generating an estimated $19.4 billion in net General Fund benefit over the 2023-2027 cycle, roughly $11.1 billion in General Fund relief and $8.3 billion in direct Medi-Cal investments. SB 136 (2024, Chapter 41) recalibrated the tax structure to align with revised CMS regulations and deferred several SB 132 rate-increase implementation dates to manage the FY 2025-26 $12 billion state deficit. SB 137 (2026 anticipated at publication) is the legislative recalibration vehicle to comply with the CMS final rule.

DHCS Budget Letter 23-15 allocated SB 132 MCO Tax investments across three buckets:

Bucket A, Workforce ($25 billion over 5 years across all sources): CalGrows ($329 million for direct-care worker training and wage augmentation), Equity and Practice Transformation Payments ($700 million to FQHCs, RHCs, and other safety-net providers), Graduate Medical Education ($150 million annually), Distressed Hospital Loan Program ($300 million+), Behavioral Health Workforce ($200 million+).

Bucket B, Provider Rate Increases: primary care, maternity care, and behavioral health targeted to ≥87.5% of Medicare rate by 2024-2026 phase-in, largely deferred under SB 136, partially restored in the FY 2026 May Revise.

Bucket C, Managed Care / CalAIM Investments: ECM and Community Supports continued capitation funding, PATH capacity-building grants ($1.85 billion+), Justice-Involved Pre-Release rollout funding ($300 million+), D-SNP/Medi-Medi Plan alignment infrastructure, Tribal investment authority.

The pending federal threat: the CMS final managed-care-tax rule (89 Fed. Reg. 87394, October 30, 2024) effectively requires that state managed-care taxes apply uniformly to all managed-care lives at non-differential rates. California's MCO tax is one of two state structures (the other is Michigan) that the rule was designed to constrain. The rule has a phase-in implementation schedule with full effect by certain dates in 2026-2028. SB 137 is anticipated to recalibrate the state's tax tiers to remain compliant. If the recalibration generates lower revenue, CalAIM funding could face downward pressure for the renewal cycle.

Transitional Rent, the federally novel housing benefit

Transitional Rent is a Community Support, sometimes called CS #15, that authorizes a Medi-Cal Managed Care plan to pay direct rent for an eligible high-need member for up to six months. It is the first §1115 Medicaid benefit in U.S. history to authorize direct rent payment as a Medicaid expenditure. CMS approved California's expenditure authority in December 2024. APL 24-029 made the benefit operational January 1, 2025, with statewide expansion January 1, 2026.

To receive Transitional Rent, a member must:

• Be enrolled in ECM with a Lead Care Manager;
• Be at risk of homelessness OR be exiting homelessness, an institutional setting (jail, prison, psychiatric inpatient, residential SUD treatment), or a recuperative care setting;
• Have an Individualized Care Plan documenting the necessity of housing assistance for clinical stabilization;
• Have an MCP that offers Transitional Rent as a CS in the relevant county.

What is covered: up to six months of rent, typically aligned with Section 8 fair market rents for the member's county. Apartments, rooms, ADUs, and tenancy arrangements where the member has a lease or sublease qualify. Hotel/motel stays (which are a separate CS category), shared family housing where the member lacks lease tenure, and mortgage payments do not qualify. Transitional Rent pairs with Housing Deposits CS for first-month rent and security deposit, and with Housing Tenancy & Sustaining Services for ongoing tenancy support.

The benefit went live January 1, 2025 with several early-adopter MCPs, Partnership HealthPlan, L.A. Care, Inland Empire Health Plan, and Health Plan of San Mateo. By January 1, 2026, most major MCPs in CalAIM counties had elected Transitional Rent as a CS.

The federal-policy stake is significant. Transitional Rent represents CMS's acknowledgment that housing instability is a determinant of health justifying federal Medicaid expenditure in narrowly tailored circumstances. It pairs with similar §1115 housing benefits in Arizona, Oregon, Massachusetts, and New York approved 2022-2024. The California precedent established a template that other states have followed. The 2027-2031 California renewal application proposes continuation of Transitional Rent and the addition of a Transitional Housing CS for members with longer durations of need.

The federal-policy risk is equally real. A future Congress or CMS administration could revoke Transitional Rent expenditure authority in the renewal cycle. DHCS' renewal application makes the case that Transitional Rent is cost-effective under standard §1115 budget-neutrality tests.

What CalAIM means for older adults, five use cases

This is the section a Brevy reader most needs. How do specific CalAIM benefits actually reach an older adult in California in 2026? Five common use cases.

Hospital discharge. When a Medi-Cal-enrolled older adult is hospitalized, the discharge planner is required (per MCP contract Article XIII and applicable APLs) to assess eligibility for ECM and CS at discharge. Real-world implementation varies, but the well-functioning pathway looks like: the discharge assessment identifies that the member is at risk of avoidable readmission; the MCP refers into ECM under POF #2 (at risk of avoidable hospital/ED utilization); Recuperative Care CS covers safe housing for members who lack it; Medically Tailored Meals CS supports recovery for members with chronic disease (CHF, diabetes, ESRD, post-surgical recovery, cancer, HIV); Personal Care & Homemaker Services CS fills gaps until IHSS authorization; Environmental Accessibility Adaptations CS covers home modifications for safe return. If the discharge plan does not include CalAIM benefits, ask the discharge planner explicitly. If the planner does not respond, call the MCP member services line. If the MCP does not respond, call the DHCS Office of the Ombudsman at 1-888-452-8609.

Nursing facility transition. For a Medi-Cal member who has been admitted to a nursing facility and is clinically able to return to community living, multiple CalAIM benefits matter. ECM POF #5/6 (community at risk for institutionalization or NF residents transitioning) provides an ECM Provider who develops a transition plan and coordinates with the NF social worker. Community Transition Services CS covers one-time set-up costs, household goods, and pre-discharge planning. NF Transition/Diversion to Assisted Living CS covers ALW-style placement when home is not viable, an important pathway for members on the ALW waitlist. Housing Deposits and Housing Transition Navigation cover housing access. Transitional Rent covers up to six months of rent. MSSP, CBAS, and IHSS, separately administered LTSS benefits, coordinate with ECM. Cross-references to our HCBS Waivers and Long-Term Care guides cover the full LTSS picture.

Home modifications. A Medi-Cal-enrolled older adult who needs grab bars, a ramp, a stairlift, or a roll-in shower has multiple potential funding paths. CalAIM's Environmental Accessibility Adaptations CS is the most accessible if (a) the member's MCP offers it (about 60% of MCPs do), (b) the modification is medically necessary, and (c) the member meets the MCP's eligibility criteria. Other paths include MSSP (capped enrollment), HCBA waiver (~6,000-person waitlist), and the federal Home Modifications fund flowing through some Area Agencies on Aging.

Medically Tailored Meals after hospital discharge. For a senior with congestive heart failure, diabetes, end-stage renal disease, or cancer-related cachexia, Medically Tailored Meals is one of the best-evidenced CalAIM benefits, with documented reductions in 30-day readmission rates in California pilot evaluations. Statewide vendors include Project Open Hand (SF Bay Area), Lori's Diabetic Delights (Inland Empire), Mom's Meals (statewide), and Front Door Communities (Los Angeles), among others. Members access MTM by calling the MCP member services line or via discharge referral.

Family caregiver respite. The Respite Services CS (added 1/1/2024) is the principal CalAIM benefit for unpaid family caregivers, typically up to 336 hours per year per member, in-home or out-of-home. Approximately 50% of MCPs offer it as of 2026. Family caregivers should ask their MCP whether Respite CS is available. If not, the family may be able to access respite under MSSP, CBAS, the regional Caregiver Resource Centers, or Title III-E National Family Caregiver Support Program. (See the California paid caregiver pathways guide.)

For California's roughly 1.6 million dual-eligibles, members with both Medicare and Medi-Cal, the 2026 expansion of Medi-Medi Plans (Exclusively Aligned Enrollment D-SNPs) to 41 counties is the most consequential CalAIM-adjacent change. Medi-Medi Plans coordinate Medicare and Medi-Cal benefits under one parent organization with one ID card, one care team, one set of benefits. ECM and CS are available to Medi-Medi Plan members through their Medi-Cal MCP.

The 2027-2031 renewal, what's coming

The CalAIM renewal application is the biggest California Medi-Cal policy event of 2026. DHCS submitted the formal application to CMS February 10, 2026. The federal public-comment period closed March 12, 2026. CMS-DHCS technical negotiations are anticipated to span the remainder of 2026, with CMS approval expected late December 2026.

The renewal application proposes:

• ECM continuation with the 10 POF framework, possible refinements including standardized minimum PMPM rates across MCPs, standardized minimum engagement hours, expanded ECM Provider capacity-building grants (PATH 2.0), and explicit coordination protocols with Medicare ACOs for dual-eligible members.
• Community Supports continuation of all 14 (15 with Transitional Rent) CS, with possible additions: a longer-duration Transitional Housing CS, a Ground Transportation Improvements CS, a Caregiver Training and Support CS, and a required "core menu" of CS that all plans would offer (Recuperative Care, Housing Navigation, Housing Tenancy & Sustaining, Medically Tailored Meals, NF-to-Community Transition, Asthma Remediation).
• Justice-Involved Pre-Release expansion from 90 to 120 days for high-complexity individuals; expansion to community-supervision (probation/parole) populations; continuation of statewide rollout to all 58 counties + all CDCR facilities by mid-2027.
• BH-CONNECT continuation including IMD authority, Clubhouse services, IPS Supported Employment, Mobile Crisis; possible expansion of peer-support eligibility and additional MAT formularies.
• Medi-Medi alignment continuation under the Matching Plan Policy (APL 24-013), with Partnership HealthPlan's planned 2027 Medi-Medi launch closing most of the remaining geographic gaps.

Three significant federal-policy risks loom over the renewal. First, federal Medicaid budget pressure, a future Congress could enact per-capita caps or block grants that constrain California's §1115 expenditure authority, with DSHP authority, CS expenditures, and Justice-Involved Pre-Release expenditures most exposed. Second, CMS guidance on CS evaluation may require enhanced cost-effectiveness evaluation as a renewal condition. Third, CMS managed-care-tax rule implementation requires SB 137 recalibration of California's MCO tax, and if recalibration generates lower revenue, CalAIM funding could face downward pressure.

12 common pitfalls

Pitfall 1: "CalAIM replaced California's HCBS waivers." Wrong. The §1915(c) HCBS waivers, HCBA, ALW, MSSP, SDP, HCBS-DD, continue to operate under independent federal authority. CalAIM CS includes some HCBS-style services (NF-to-AL, NF-to-Home, Personal Care, Environmental Accessibility) but these are managed-care benefits, not waiver entitlements with formal waitlists.

Pitfall 2: "Community Supports are entitlements." Wrong. CS are NOT entitlements. The MCP elects which CS to offer; the MCP applies eligibility criteria and may decline to authorize CS for a specific member. A member denied a CS has appeal rights (state fair hearing) but no entitlement to receive a CS not offered by the plan.

Pitfall 3: "ECM is direct service delivery." Wrong. ECM is care coordination, a Lead Care Manager, an Individualized Care Plan, warm hand-offs, navigation. ECM is NOT medical care, NOT IHSS, NOT residential care.

Pitfall 4: "Justice-Involved Pre-Release is automatic for all California inmates." Wrong. Pre-Release coverage is county-by-county rolling, not all 58 county jails are live; clinically eligible individuals only, must meet at least one of the 8 clinical-eligibility criteria; within the 90-day pre-release window. Many inmates do not qualify.

Pitfall 5: "Transitional Rent is a long-term housing benefit." Wrong. Transitional Rent is up to six months of rent, paired with intensive ECM services, intended to bridge a member to longer-term housing solutions (Section 8, BHSA bond housing, market rate, family housing).

Pitfall 6: "All MCPs offer the same Community Supports." Wrong. CS adoption varies significantly by MCP. The average MCP offered 8 of 14 CS in Q4 2025. Members who change MCPs may gain or lose access to specific CS.

Pitfall 7: "ECM is the same as the old Whole Person Care." Mostly wrong. ECM consolidates WPC and HHP but is structurally different: delivered through MCPs as a benefit (not through county-led pilot funding), paid PMPM (not by encounter), governed by DHCS APLs (not by individual pilot Special Terms), and accessible statewide (not just in pilot counties).

Pitfall 8: "DMC-ODS is in every county." Wrong. DMC-ODS is opt-in. As of 2026, 40 of 58 counties participate. Non-DMC-ODS counties (mostly small rural counties) operate legacy fee-for-service Drug Medi-Cal with a more limited service menu.

Pitfall 9: "BH-CONNECT eliminated the IMD exclusion in California." Partially wrong. BH-CONNECT authorized federal Medicaid match for short-term IMD stays under specific conditions (≤60-day average length of stay; specific facility size and certification requirements). The federal IMD exclusion remains in effect, BH-CONNECT created a narrowly defined §1115 carve-out.

Pitfall 10: "Medi-Medi Plan alignment is required for all dual-eligibles." Wrong. Members may opt into a Medi-Medi Plan but are not required to join one. However, in 41 EAE counties as of 2026, NEW Medicare Advantage enrollment for full-benefit duals must auto-align to the matching parent organization's Medi-Cal plan, and non-aligned D-SNPs are CLOSED to new full-benefit dual enrollment. Existing non-aligned D-SNP members may remain.

Pitfall 11: "MCO Tax revenue all flows to CalAIM." Wrong. MCO Tax revenue flows in three buckets, workforce, provider rate increases, managed care/CalAIM, and a substantial share goes to General Fund relief. CalAIM gets a meaningful but not majority share.

Pitfall 12: "ECM and Community Supports are accessible to fee-for-service Medi-Cal members." Wrong. ECM and CS are managed-care benefits delivered through MCPs. Fee-for-service Medi-Cal members (~10% of the Medi-Cal population) are NOT eligible for ECM or CS. The 2027-2031 renewal application contemplates whether to extend selected CS to FFS members, but this is not finalized.

12-question FAQ

Bottom line

Six things to take away:

1. CalAIM is delivered through your MCP. It is not a separate program, separate card, or separate enrollment. The benefits flow through Anthem, Health Net, Molina, Blue Shield Promise, Kaiser, L.A. Care, IEHP, Partnership HealthPlan, CalOptima, Health Plan of San Mateo, and the other plans serving your county.
2. The two flagship benefits are ECM and Community Supports. ECM is intensive in-person care coordination by a Lead Care Manager. CS are 14, now 15 with Transitional Rent, pre-approved alternative services. Together they cover housing, food, medical respite, home modifications, transitions, behavioral health, and respite.
3. Adoption varies by plan and county. The average MCP offered 8 of 14 CS in late 2025; L.A. Care offered 14; some plans offered only 4. Always confirm with your MCP member services line before assuming a benefit is unavailable.
4. CalAIM is NOT a replacement for HCBS waivers. HCBA, ALW, MSSP, the HCBS-DD waiver, IHSS, CBAS, and PACE continue to operate under their independent federal authorities, with their own waitlists and entitlements. CalAIM CS supplements but does not replace these.
5. The 2027-2031 renewal is pending CMS approval. All current benefits are anticipated to continue, with refinements including a possible required "core menu" of CS, expansion of Justice-Involved Pre-Release, and continuation of Transitional Rent.
6. Your escalation path: call your MCP member services line first. If the plan does not respond, call DHCS Office of the Ombudsman at 1-888-452-8609.

Resources

Learn More

• California Medi-Cal Overview
• Choosing a Medi-Cal Managed Care Plan
• California HCBS Waivers
• Medi-Cal Long-Term Care
• Medi-Cal Eligibility & Income Limits
• California IHSS Guide

Find personalized help navigating CalAIM and Medi-Cal benefits at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.