• Building the Complex Care Field

• Care Management & Redesign

• Strengthening Ecosystems of Care

• Funding & Financing

Background

The California Medicaid transformation effort known as CalAIM presents a tremendous opportunity for community-based organizations (CBOs) that provide social services to individuals with complex health and social needs. Central to this transformation is the creation of new Medi-Cal benefits that CBOs can offer, including Enhanced Care Management and Community Supports for high-needs populations.

Transitioning to incorporate Medicaid-funded payments through contracts with managed care organizations (MCOs) can be daunting for many CBOs. It necessitates projecting new revenue sources and evaluating if anticipated revenue will cover expected program expenses both at startup and over time.

Under CalAIM’s Providing Access and Transforming Health (PATH) initiative, the Camden Coalition partners with organizations in various counties, acting as a technical assistance (TA) provider in the TA Marketplace and as a facilitator in the Collaborative Planning and Implementation (CPI) Initiative. These roles aim to bolster the capacity and infrastructure of local service providers to effectively engage in transforming the Medi-Cal delivery system.

Through this collaboration, we learned that community-based providers often struggle to assess the business viability of offering Enhanced Care Management and Community Supports.

As a nonprofit organization, we resonate with the adage, “No margin, no mission.” Financial viability is crucial for any organizational leader aiming to enhance services for individuals with complex health and social needs. The CalAIM budget estimator tool is designed to facilitate informed discussions about future programming and the financial feasibility of providing new Medi-Cal services.

What is the CalAIM Budget Estimator Tool?

The CalAIM budget estimator tool is an Excel-based template that helps organizations estimate costs and potential revenue from providing Medi-Cal Enhanced Care Management and selected Community Support Services, including housing-related services and medically tailored meals.

Key Features:

1. Built-in Assumptions: The tool incorporates assumptions about payment structures for these services, as outlined in the California Department of Health Care Services CALAIM Enhanced Care Management Policy Guide and Community Supports Policy Guide.

2. Cost Input: Users can enter organization-specific expenses such as staffing costs and other direct and indirect costs.

3. Revenue Customization: It includes generic rate ranges and areas for customizing expected revenue sources to calculate the program margin (ratio of revenue to expenses).

4. Summary Tab: A summary tab displays the projected margin by program year, helping users understand if their assumptions lead to a fiscally viable program.

The CalAIM budget estimator enables organizations to model various scenarios for their programs. This capability supports meaningful feasibility discussions with financial officers and other decision-makers. It also organizes and highlights critical information necessary to justify rate requests to MCOs during contract negotiations.

Getting Started

Ready to craft your budget? Click the link below to download the budget estimator tool in Excel format:

Download the Budget Estimator Tool in Excel Format

By using the CalAIM budget estimator, CBOs can more confidently navigate the financial aspects of contracting with managed care organizations, ensuring that they can sustain their missions while expanding their service offerings under CalAIM.