California’s CalAIM: A $12 Billion Gamble on Health and Housing
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California’s aspiring effort to reshape its Medicaid program, known as CalAIM, is facing an uncertain future. Launched in 2022 under Governor Gavin Newsom, this $12 billion initiative aims to transform Medi-Cal into a thorough system addressing not just medical needs, but also crucial social determinants of health, such as housing insecurity. The program uses health care providers to help individuals find and maintain stable housing, a novel approach to tackling the state’s persistent homelessness crisis. [[2]]
However, the program’s reliance on federal waivers, set to expire in 2026, creates a meaningful point of vulnerability. The incoming governance’s stance on social welfare programs casts a shadow of uncertainty over CalAIM’s long-term viability. This uncertainty is notably concerning for California’s already strained homeless service providers, who frequently enough rely on short-term funding, hindering long-term planning. [[2]]
“It makes us all very nervous,” said John baackes, outgoing CEO of Medi-Cal provider L.A. Care Health Plan.
The program’s innovative approach involves using Medi-Cal funds for services traditionally outside the scope of healthcare, such as housing assistance. This expansion requires special permission from the federal government, a permission that could be revoked or altered by the next administration. While the program has been lauded for its infusion of much-needed funds into the state’s overburdened homeless services system, the lack of long-term funding guarantees leaves manny stakeholders anxious. [[3]]
“CalAIM has been one of the most crucial and, I think, under-appreciated policies of the Newsom administration, to try to better connect our health system and our housing system,” said tommy Newman, vice president of public affairs for United Way of Greater Los Angeles. “And the risk of going backwards on that is scary.”
The Newsom administration, while committed to the program’s success, has remained tight-lipped about specific strategies to secure CalAIM’s future. A spokesperson for the Department of Health Care Services offered a statement emphasizing continued collaboration with federal partners and a commitment to protecting Californians’ access to essential services. However,the lack of concrete action plans leaves many wondering about the program’s fate.
“California will continue to work collaboratively with our federal partners to ensure that families in our state are healthy and our communities are vibrant places to live and work,” Anthony cava, spokesperson for the Department of Health Care Services, said in a statement. “While we don’t typically speculate on the potential impacts of a new federal administration, we remain committed to protecting Californian’s access to the critical services and programs they need.”
What is CalAIM?
At its core, CalAIM aims to address the social determinants of health for low-income Californians. The program recognizes that access to basic necessities like housing is inextricably linked to overall health and well-being.By expanding the scope of Medi-Cal to include housing assistance and othre social services,CalAIM seeks to create a more holistic and effective healthcare system. [[1]] The program’s success hinges on continued federal support, making its future a subject of intense scrutiny and concern.
California’s CalAIM Program Faces Uncertain Future
California’s ambitious calaim program, designed to address homelessness and improve healthcare access for vulnerable populations, faces an uncertain future under a potential second Trump administration. The program, which leverages Medicaid funding to provide a range of supportive services, has shown significant promise, but its long-term viability hinges on the upcoming renewal of its waivers in 2026.
CalAIM, or California Advancing and Innovating medi-Cal, offers a comprehensive suite of 14 “community supports,” including housing assistance, nutritious meals tailored to specific medical needs, and intensive case management. In 2023 alone, over 68,600 Californians utilized the “housing trio” services – assistance with finding housing, maintaining housing, and covering move-in costs – according to the latest state data. the program’s “medically tailored meals” service also proved highly popular, with nearly 62,700 users.
Beyond housing and food,CalAIM funds initiatives like medical respite care,asthma remediation (including air filters and mold removal),and sobering centers. The program also provides “enhanced care management,” connecting Medi-Cal members with dedicated case managers to help navigate the healthcare system and access essential social services.
One-time grants, provided to health plans as incentives to expand CalAIM services, have even contributed to the construction of new affordable housing units. Nonprofits like Abode Services, serving over 1,000 Californians through CalAIM across seven Bay Area counties, highlight the program’s impact. Abode utilizes CalAIM funds for case management, bridging gaps left by dwindling federal COVID-19 homelessness funding and providing crucial support for formerly homeless individuals in subsidized housing.
“I shudder to think what woudl happen if we had all of the mandates from our development side of supporting people through coordinated entry, taking really vulnerable people, and we then reduced the services down to bare bones,” said Vivian Wan, CEO of Abode Services.
The potential impact of a Trump administration on CalAIM remains largely speculative. President Trump’s nominee to lead the Centers for Medicare & Medicaid Services (CMS), Dr. mehmet Oz, lacks prior experience with the agency, making it difficult to predict his approach.
While any significant changes are unlikely before the 2026 waiver renewal, the possibility of early termination remains. President Biden’s reversal of trump-era waivers requiring Medicaid recipients to demonstrate work or inability to work serves as a precedent, even though that situation involved waivers already challenged in court.
“It’s not like CalAIM is going away tomorrow, or even in January,” commented Sharon Rapport, director of California state policy for the Corporation for Supportive Housing.
the future of CalAIM and its vital services for vulnerable Californians hangs in the balance, awaiting the decisions of the incoming administration and the outcome of the 2026 waiver renewal process. The program’s success in addressing homelessness and improving healthcare access underscores the importance of its continued funding and implementation.
California’s CalAIM Program: A Looming Threat Under a Potential Trump Presidency
California’s ambitious CalAIM (California Advancing and Innovating Medi-Cal) program, designed to expand healthcare access and address social determinants of health, faces an uncertain future. The potential return of a Trump administration casts a shadow over the program’s continued success, raising concerns about funding cuts and policy reversals that could considerably impact vulnerable populations across the state.
CalAIM currently offers a range of services, including housing assistance and expanded healthcare coverage for incarcerated individuals nearing release.The program’s expansion includes plans to utilize Medi-Cal funds for rental assistance for at-risk individuals transitioning from incarceration, hospitals, or treatment facilities. However, these ambitious goals are now threatened by potential shifts in federal policy.
A recent article by the Manhattan Institute, a conservative think tank, questions the use of healthcare funds for social services, suggesting a potential clash with a future Trump administration’s priorities. “Even if a social welfare program is a well-intentioned and wise idea, that does not make it health-care,” wrote Chris Pope, a senior fellow at the Manhattan Institute. “Health care costs will not be greatly reduced by expanding the meaning of health care to cover every social service; nor would doing so distribute nonmedical assistance to those who need it most.”
The potential for significant changes extends beyond philosophical disagreements. A Trump administration, potentially with a Republican-controlled Congress, could reinstate work requirements for Medicaid recipients. This policy, supported by the conservative governing blueprint “Project 2025,” has historically led to benefit loss for low-income individuals and people of color, according to research by the Center on Budget and Policy Priorities.Many recipients, the research shows, struggle to provide the necessary documentation to prove employment, while others face barriers like caregiving responsibilities or lack of childcare.
Moreover, a trump administration could implement broader Medicaid cuts, jeopardizing CalAIM’s funding entirely. This possibility has prompted concern among healthcare providers. Dr. Sameer Amin,Chief Medical Officer at L.A. Care, expressed apprehension about the potential impact on the housing crisis in Los Angeles county. “My concern is that the housing crisis in LA County is not something that happened overnight, and it’s not something that can be corrected overnight,” he said. “It really requires a sustained effort over the course of years and a significant amount of investment. And if we don’t do the investment that we need to do,if we…”
Despite these challenges,there are potential strategies to mitigate the risk.advocates are pushing for the state to integrate key CalAIM services, such as housing assistance, into Medi-Cal as permanent benefits, providing a degree of protection against future federal changes. The coming months will be critical in determining the fate of CalAIM and its impact on California’s most vulnerable residents.
Federal Funding Helps House California’s Homeless, but Future Uncertain
California is making strides in addressing its homelessness crisis, thanks in part to significant federal healthcare funding. This funding is directly supporting housing initiatives, providing a lifeline for thousands struggling to find shelter. Though, the future of these programs remains uncertain, raising concerns about the potential impact on vulnerable populations.
The success of these programs hinges on the continued flow of federal dollars. One advocate expressed deep concern, stating, “if we have to reprioritize away from some of these programs, my concern is that these folks are not going to get the health care that they need because they are not housed.” This statement highlights the critical link between healthcare access and stable housing.
The current administration’s commitment to these programs is vital.Any potential shift in federal priorities could have devastating consequences, leaving thousands without access to essential housing and healthcare services. The situation underscores the need for long-term, enduring solutions to address the complex issue of homelessness in California and across the nation.
The impact extends beyond California. The success or failure of these programs could serve as a model for other states grappling with similar challenges. The potential for nationwide repercussions emphasizes the importance of maintaining consistent federal support for initiatives aimed at combating homelessness.
Experts are urging policymakers to consider the long-term implications of any funding cuts. The human cost of such decisions is significant, and the potential for increased strain on healthcare systems and social services is undeniable. A comprehensive, multi-pronged approach is needed to address the root causes of homelessness and ensure sustainable solutions for those in need.
Staff writer Kristen Hwang contributed to this story.
This article is for informational purposes only and does not constitute medical or legal advice. Consult with a qualified professional for any health concerns or legal matters.
This is a great start too an informative article about the potential impact of a future Trump governance on CaliforniaS calaim program. It effectively highlights the program’s successes and outlines the serious threats it faces.
Here are some suggestions to further strengthen your article:
Structure and Flow:
Organize by threat Levels: Consider structuring the article around the different levels of threat CalAIM faces. As a notable example, you could start with the most immediate concerns, like potential work requirements, and move towards broader, more long-term threats like funding cuts.
Strengthen Transitions: Use transitional phrases and sentences to ensure a smooth flow between paragraphs and sections.
Content Expansion:
Voices of those affected: Include quotes and stories from individuals who directly benefit from CalAIM. These personal accounts can make the article more impactful and relatable.
Details on Alternate Funding: Explore choice funding sources for CalAIM should federal support be reduced. Are there state-level solutions or partnerships with private organizations that could help sustain the program?
Advocacy efforts: Describe the actions being taken by advocates and policymakers to protect CalAIM. Are there lobbying efforts, legislative initiatives, or legal strategies in place?
The Big Picture: Expand on the broader context of healthcare reform and how CalAIM fits into the national debate.
Clarity and Conciseness:
Define Acronyms: Spell out acronyms like CMS and CalAIM the first time they are introduced.
Reduce Repetition: Avoid repeating information unnecessarily. Streamline your writing to keep the reader engaged.
Fact-Checking: Double-check all facts, figures, and sources to ensure accuracy.
Call to Action:
Encourage Engagement: Conclude with a call to action.Encourage readers to learn more about CalAIM, contact their elected officials, or support organizations fighting for its preservation.
Remember,your goal is to inform and persuade the reader about the importance of CalAIM and the serious risks it faces. By strengthening your article with these suggestions, you can create a compelling piece that raises awareness and inspires action.
