San Diego Advancing and Innovating Medi-Cal (SDAIM)

Materials

One-pagers about Enhanced Care Management, Community Supports, and Transportation for Medi-Cal members are now available at the links below. Please help us share them with your clients. (translations coming soon)

• Enhanced Care Management for Medi-Cal Members
• Community Supports for Medi-Cal Members
• Transportation for Medi-Cal Members

Enhanced Care Management and Community Supports 

Enhanced Care Management (ECM) is available for select Medi-Cal members with complex needs. Enrolled members receive comprehensive case management from a lead care manager who coordinates health and social services.

To connect an individual to ECM:

1. Confirm the individual has active Medi-Cal and identify their Managed Care Plan (MCP).
2. Ensure the individual meets the eligibility criteria for ECM in the ECM Policy Guide.
3. Complete the universal or plan specific ECM referral form linked below and email the form to the assigned MCP’s designated email address. The Universal ECM Referral Form is accepted by all plans.

Note that the MCP should authorize ECM services within 5 working days for routine authorizations and within 72 hours for expedited requests. If you have not received a response, email or call the MCP for an update.

Community Supports are medically appropriate and cost-effective services provided by MCPs to help members address their health-related social needs.

The 14 services are: 

Community Supports are available to a wide range of members, including those with complex needs and those who are enrolled in ECM. However, members do not need to be enrolled in ECM to access Community Supports.

To connect an individual to Community Supports:

1. Confirm the individual has active Medi-Cal and identify their Managed Care Plan (MCP).
2. Ensure the individual meets the eligibility criteria for Community Supports in the Community Supports Policy Guide.
3. Complete the plan specific Community Supports referral form linked below for each service needed and email the form(s) to the assigned MCP’s designated email address.

SDAIM Updates

About SDAIM

San Diego Advancing and Innovating Medi-Cal (SDAIM) refers to the County of San Diego Health and Human Services Agency’s local approach to the Department of Health Care Services’ California Advancing and Innovating Medi-Cal (CalAIM) initiative. SDAIM partners and collaborates with County departments, managed care plans, health and social care providers, community organizations, consumers, and advocates to support CalAIM implementation in San Diego County.

Public Participation

• October 2023: Live Well Advance Pre-Conference
  
  The SDAIM team presented an overview of the California Advancing and Innovating Medi-Cal (CalAIM) program which focused on the new services that are available for Medi-Cal members and how to access them, as well as local CalAIM implementation and how you can get involved.

• February 2023: Community Listening Sessions

     o   Video Recording
     o   Presentation Slides
     o   Question and Answer

SDAIM Roadmap

The SDAIM Roadmap was developed based on stakeholder input and outlines the County’s roles, priority areas, data and evaluation priorities, and initial implementation steps.

Email SDAIM.HHSA@sdcounty.ca.gov with questions or feedback.

Board of Supervisors Actions

May 23, 2023: Receive the San Diego Advancing and Innovating Medi-Cal Roadmap and Authorize an Intergovernmental Transfer Agreement for Behavioral Health Services

• Board Letter, SDAIM Roadmap, Video Recording (2:53:50 - 3:07:10), and Presentation Slides
  

Upcoming Events

As the selected facilitator for your San Diego County PATH CPI Collaborative, Intrepid Ascent is responsible for hosting and facilitating monthly convenings and working with participants to develop programmatic activities contributing to CalAIM’s whole system, person-centered approach to care. CPI participants in San Diego County meet regularly to identify Enhanced Care Management (ECM) and Community Supports needs and gaps within the community, identify and resolve implementation issues, and monitor how Providing Access and Transforming Health (PATH) funds can be used to address implementation issues and disseminate best practices. Additionally, Intrepid Ascent hosts monthly office hours and/or CalAIM Academy meetings for continued relationship building and follow-up on key topics.

For past CalAIM Academy sessions and resources, upcoming sessions, and other information, see Intrepid Ascent's CalAIM Academy website.

San Diego Path CPI Collaborative Monthly Meetings

Office Hours (Register Here)

If you have any questions or concerns, please contact emily@intrepidascent.com.  

Sign up to receive alerts about future SDAIM events. 

Additional Information and Resources

For more information on CalAIM and associated programs, click below to see additional resources: