California efforts to address behavioral health and SDOH: A look at whole person care pilots

The “California Advancing and Innovating Medi-Cal” (CalAIM) initiative was recently approved by the Centers for Medicare and Medicaid Services (CMS) and launched in January 2022. CalAIM seeks to improve health outcomes and advance health equity for “Medi-Cal” (Medicaid) beneficiaries and other low-income people in the state. As of September 2021, over 13 million people were enrolled in Medi-Cal in California – the largest Medicaid program in the nation. CalAIM will leverage Medicaid as a tool to help address complex challenges, including behavioral health access, the health needs of people experiencing homelessness, and the complex clinical needs of justice-involved populations. Central to the demonstration is a person-centered approach, first authorized as “Whole Person Care” (WPC) pilots implemented through a waiver approved by the federal government under section 1115 of the Medicaid statute (known as “Medi-Cal 2020”). The WPC pilot program aimed to coordinate and integrate physical health, behavioral health, and social services for Medicaid enrollees with complex needs. Under CalAIM, the state will incorporate and transition WPC pilot services statewide through the state’s Medicaid managed care system. The California initiatives are part of a growing movement to better meet behavioral health needs and improve equity and health by addressing underlying social determinants.