CalAIM: California Medicaid's Medi-Cal Overhaul, Explained

There is no CalAIM application, no CalAIM card, and no CalAIM office. CalAIM (California Advancing and Innovating Medi-Cal) is not a program you sign up for. It is a top-to-bottom overhaul of California Medicaid, and the benefits it created are things you request through the Medi-Cal managed care plan your family member already has. CalAIM produced two flagship benefits, Enhanced Care Management and Community Supports, and the rule that trips up most families is that the second one varies by plan and county: the benefit you want most can exist in the next county and be missing in yours. This guide explains, in plain language, what CalAIM is in 2026, what it covers, why availability depends on your plan, and exactly how an older Californian or family caregiver can ask for the right benefit from the right place.

In This Guide

• What CalAIM Is in California's Medicaid Program
• Enhanced Care Management: Coordination, Not Care
• Community Supports: Why Your Plan and County Decide
• Transitional Rent: Medi-Cal's Short-Term Rental Assistance
• CalAIM Did Not Replace California's HCBS Waivers
• What CalAIM Means for Older Adults
• How to Request CalAIM Benefits on California Medicaid
• What's Changing: The 2027 Renewal
• Frequently Asked Questions
• Learn More

What CalAIM Is in California's Medicaid Program

CalAIM is a restructuring of how Medi-Cal, California Medicaid, delivers care. It is built on two federal authorities: a Section 1115(a) demonstration and a parallel Section 1915(b) managed-care waiver, established in state law by Assembly Bill 133 (2021). CMS approved both on December 29, 2021, and CalAIM launched January 1, 2022, with the approval running through December 31, 2026.1

CMS describes Medi-Cal as one of the nation's largest and most complex Medicaid systems. DHCS counted 13,910,180 Medi-Cal certified eligibles in April 2026, and says about one in three Californians receive health care services it administers.2 It is administered by the California Department of Health Care Services (DHCS), and California's 58 counties conduct Medi-Cal eligibility determinations. CalAIM does not change who qualifies for Medi-Cal; it changes what a member with complex needs can ask their plan to do.

The single most important thing to understand is the delivery channel. CalAIM's two flagship benefits flow through Medi-Cal managed care, so the access point is the managed care plan a member is enrolled in. Roughly 90% of Medi-Cal members receive their care through a managed care plan rather than fee-for-service.3 Because both flagship benefits are delivered by the plans, a member still in fee-for-service has no plan to request them from; if that is your situation, ask Health Care Options whether you can enroll in a managed care plan in your county.

Enhanced Care Management: Coordination, Not Care

Enhanced Care Management (ECM) is a statewide Medi-Cal benefit for members with the most complex needs, delivered by a single Lead Care Manager.1 Think of it as coordination, not care itself: one named person organizes a member's care across doctors, specialists, behavioral health, social services, and the Community Supports below.

ECM is organized around defined Populations of Focus, the high-need groups DHCS prioritizes.1 There is no separate ECM application form: plans identify eligible members and assign the Lead Care Manager, so the practical step is to call your plan and ask whether your family member qualifies. The DHCS Enhanced Care Management page lists who currently qualifies. A Lead Care Manager coordinates and connects rather than delivering hands-on care, and that includes helping a member apply for In-Home Supportive Services (IHSS), a separate program administered by the California Department of Social Services in which a county social worker assesses and documents the need for hours.4

Community Supports: Why Your Plan and County Decide

Community Supports are 14 pre-approved services, formerly called In Lieu of Services, that Medi-Cal managed care plans may elect to offer in place of standard Medi-Cal benefits.1 They are not entitlements. Each plan chooses which Community Supports to offer in its service area, and DHCS encourages, but does not require, plans to offer as many as possible. That is why the benefit a family wants can be available on one plan and absent on another in the same situation.

DHCS publishes the full list, the official service definitions, and a county-by-county record of which plans have elected which Community Supports. The DHCS-named Community Supports most relevant to older adults and their caregivers are below; the descriptions are our plain-language summaries rather than the official service definitions, so confirm the exact terms with your plan.

Before assuming a benefit is unavailable, call your plan's member services line and ask plainly: does this plan offer this Community Support in my county, and how do I get a referral? If your plan does not offer it, you may be able to switch to one that does, or request the equivalent service through a separate program such as an HCBS waiver.

Transitional Rent: Medi-Cal's Short-Term Rental Assistance

Short-term rental assistance, which DHCS has also called Transitional Rent, covers up to six months of rent or temporary housing for eligible high-need members. Its authority and its schedule come from California's BH-CONNECT demonstration rather than from the CalAIM Community Supports list, so it is not a fifteenth Community Support. The governing federal Special Terms and Conditions set a phased schedule: no sooner than July 1, 2025 it is an optional service for managed care plans; no sooner than January 1, 2026 it is mandatory for plans to provide to members who meet the access criteria for specialty mental health services, Drug Medi-Cal, or the Drug Medi-Cal Organized Delivery System, and remains optional for other eligible populations; and no sooner than January 1, 2027 it becomes mandatory for all eligible populations.1 Because access turns on those criteria and on where your plan sits in that phase-in, ask your plan directly whether the benefit is available to your family member today.

CalAIM Did Not Replace California's HCBS Waivers

A common misunderstanding is that CalAIM replaced California's home- and community-based services (HCBS) waivers. It did not. The Section 1915(c) waivers operate under their own independent federal authority, each with its own lead agency, rules, and waitlist:5

• The Home and Community-Based Alternatives (HCBA) Waiver, run by DHCS, for people at a nursing-facility or acute-hospital level of care.
• The Assisted Living Waiver (ALW), run by DHCS, which pays for care (but not room and board) in a residential care facility and operates in only 15 counties, with a large waitlist.5
• The Multipurpose Senior Services Program (MSSP), delivered by local agencies under contract with the California Department of Aging, for older adults who have Medi-Cal and are certified or certifiable for nursing-facility placement. Note an unresolved discrepancy on the age floor: DHCS publishes 65 and older for MSSP, while the Department of Aging publishes 60 and older on its own MSSP page, so confirm the age rule with the MSSP site serving your county.5

This boundary matters because the Community Supports menu includes HCBS-style services. The Nursing Facility to Assisted Living Community Support, for example, overlaps with the Assisted Living Waiver, but the two are different things: the Community Support is an optional benefit your plan may elect to offer, while the waiver runs under its own federal authority in its 15 counties, with the large waitlist noted above. Community-Based Adult Services (CBAS) is likewise a separate Medi-Cal managed care benefit rather than a CalAIM Community Support.5 In-Home Supportive Services is separate again, administered by the California Department of Social Services with county welfare departments handling intake, eligibility, and assessment.4

What CalAIM Means for Older Adults

For an older Californian on Medi-Cal, CalAIM is most useful at a few specific moments. When a member is discharged from the hospital, ask the discharge planner whether ECM and Community Supports such as Recuperative Care, Medically Tailored Meals, or home modifications apply. When a member is in a nursing facility and could return to the community, ECM plus the Nursing Facility transition Community Supports can help plan the move. When a family caregiver is exhausted, the Respite Services Community Support, where a plan offers it, provides temporary relief.

CalAIM also added two changes that matter for Medi-Cal members who also have Medicare. Medi-Medi Plans, Medicare Advantage plans for people with both Medicare and Medi-Cal, expanded from 12 counties to 41 counties effective January 1, 2026.3 ECM and Community Supports are delivered by the Medi-Cal plan, so a dual-eligible member asks the Medi-Cal side rather than the Medicare side. Behavioral health expanded too: BH-CONNECT (Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment) is a separate Section 1115 demonstration that CMS approved effective January 1, 2025 through December 31, 2029.1

One more CalAIM milestone sits outside senior care but is worth naming. On January 26, 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and eligible adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release, under what DHCS calls the Justice-Involved Reentry Initiative.1 Its relevance to most families is the re-entry care transition it funds; ask the facility or the plan whether it is operating where your family member is.

How to Request CalAIM Benefits on California Medicaid

There is no single CalAIM phone line, so the steps below are the reliable path. Note that these benefits are delivered through a Medi-Cal managed care plan, so a member needs Medi-Cal coverage and a plan before either one is reachable.1

What's Changing: The 2027 Renewal

CalAIM's current federal approval runs through December 31, 2026.1 DHCS submitted its renewal application to CMS on May 11, 2026, seeking a five-year renewal that would implement the demonstration through December 31, 2031 and expand CalAIM's reach from 2027 through 2031.1 The renewal is still pending, and which benefits carry forward on what terms depends on CMS approval. For planning purposes, families can rely on the current benefits being in place through at least the end of 2026, and should confirm any specific benefit with their plan before counting on it.

A second California deadline falls on the same date, and it is about money rather than authority. California finances a substantial share of Medi-Cal through its Managed Care Organization (MCO) tax, a federally allowable Medicaid financing mechanism in which a per-member tax on managed care plans generates revenue that the state, with federal matching funds, puts toward Medicaid spending. The current tax was authorized by Assembly Bill 119 (2023), effective April 1, 2023 through December 31, 2026, and amended by Senate Bill 136 and Assembly Bill 160 (2024); CMS approved the tax waiver in December 2023 and the increased-tax amendment in December 2024. Proposition 35, approved by California voters in November 2024, permanently establishes state authority for the MCO tax and restricts how the revenue may be used, depositing it in the Protect Access to Health Care Fund, with new spending rules from 2027 onward.8

The gross figure overstates what the state actually has to spend. Per the Legislative Analyst's Office in February 2025, the tax generates more than $12 billion in gross revenue annually, but less than $8 billion in net revenue is available to the state to spend, because Medi-Cal payments to plans cover each plan's cost of paying the tax on its Medi-Cal enrollment; the Governor's 2025-26 budget assumed $27 billion in net MCO tax revenue through 2026-27.8 None of this changes what a member can request from their plan today, but it is why California's Medi-Cal budget debates keep returning to the MCO tax, and why the funding side of 2027 is a separate question from the federal renewal above.

Learn More

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.