CalAIM Community Supports Policy Guide: A Closer Look | Exym EHR

CalAIM Community Supports

Community Supports are alternative options offered in place of the standard services covered by Medi-Cal Managed Care Plans (MCPs) under California’s Medicaid State Plan. These supports aim to deliver various services and resources to meet the needs of Medi-Cal members within the community, prioritizing health, stability, and independence. These services may include: 

• Support to secure and maintain housing
• Access to medically tailored meals to support short-term recovery
• A variety of other community-based services

Community Supports help address Medi-Cal members’ health-related social needs so they can live healthier lives and avoid higher, costlier levels of care.

Currently, there are 14 pre-approved Community Supports that can be offered to Medi-Cal members by MCPs. The Medi-Cal Community Supports Facts Sheet identifies them as:

CalAIM Community Supports Policy Guide

If you’re looking for more detailed and in-depth information about CalAIM Community Supports, you should reference the CalAIM Community Supports Policy Guide. This is an extensive resource document which:

• Introduces Community Supports and explains how to add and discontinue services, obtain referrals, and understand timelines
• Clearly defines each type of Community Support service and what is covered
• Summarizes how Community Supports can potentially be used as substitutes in lieu of state plan services and settings 
• Explains how to engage members in Community Supports throughout the authorization process, continuity of care, and the deauthorization process
• Gives in-depth information on provider contracting, enrollment, credentialing, and vetting requirements
• Outlines data system and data sharing requirements for IT infrastructure necessary for MCPs to run Community Supports
• Explains Community Support billing and invoicing guidelines and the HCPCS codes that must be used for services
• Offers monitoring, oversight, and reporting guidance for MCPs and subcontractors
• Explains the application requirements for obtaining state approval to add any additional Community Supports not already on the pre-approved list

CalAIM Community Supports are Part of Medi-Cal’s Transformation

According to the California Department of Health Care Services (DHCS), CalAIM Community Supports are part of an ongoing transformation currently taking place within Medi-Cal through the CalAIM Initiative. This initiative is shifting the focus of Medi-Cal towards a whole-person care model, which:

• Removes traditional healthcare barriers by bringing care out into communities instead of into hospitals and offices
• Introduces better ways to coordinate care
• Provides in-person care management to high-need members where they live

Another main focus of the CalAIM transformation is Enhanced Care Management (ECM), where members can access improved services that provide well-rounded care beyond the doctor's office or hospital, addressing both their physical and mental health needs. ECM and Community Supports work hand-in-hand to create a coordinated, person-centered, and equitable health system that will serve all Californians more effectively. 

While Community Supports play a prominent role in Enhanced Care Management, they are also available to eligible Medi-Cal members regardless of whether they qualify for ECM services. In fact, all Medi-Cal managed care plans (MCPs) are encouraged to offer as many of the 14 pre-approved Community Supports as possible to members who need them.

Is Your Agency Part of CalAIM Community Support Services or Enhanced Care Management? 

Navigating CalAIM Community Support services and Enhanced Care Management requires strong technological capabilities for documentation, billing, and collaboration with other providers. At Exym, we understand California’s unique billing requirements, have navigated Medi-Cal and CalAIM reforms, and are ready to support your agency in whatever comes next.

Exym is a comprehensive EHR software solution designed specifically for behavioral health agencies. Trusted for 20+ years, our intuitive and customizable software empowers providers to improve client outcomes, manage revenue cycles, and increase agency efficiency. Exym allows you to spend more time on what matters most- the clients in your care.

We have long-standing, trusted partnerships in California and are here to help! Book a demo today to get more information and talk to our Exym experts.