Introduction
Welcome to the Medi-Cal and CalAIM Implementation Toolkit for Domestic Violence Organizations. This comprehensive resource is designed to help domestic violence service providers navigate California's Medicaid program (Medi-Cal) and leverage the California Advancing and Innovating Medi-Cal (CalAIM) initiative to better serve survivors. For domestic violence organizations, understanding Medi-Cal is essential as many survivors may be eligible for coverage, and new initiatives like CalAIM are creating opportunities to better serve this population through the healthcare system.
Purpose of this Toolkit
This toolkit provides practical information and guidance to help domestic violence organizations:
Understand the fundamentals of Medi-Cal and CalAIM
Explore new service opportunities through Enhanced Care Management (ECM), Community Supports, and Community Health Workers
Navigate the contracting and credentialing processes with Managed Care Plans
Implement appropriate infrastructure for billing and reporting
Maintain confidentiality and protect survivor information
Access resources and support for successful implementation
How to Use this Toolkit
Each section of the toolkit addresses a specific aspect of Medi-Cal and CalAIM implementation. You can approach the toolkit sequentially or focus on sections most relevant to your organization's current needs. Each section will have main content while some sections will have addendums and/or “helpful links” pages.
Whether your organization is exploring Medi-Cal participation for the first time or looking to expand services under CalAIM, this toolkit offers valuable information to support your journey. The content is designed to be accessible regardless of your prior knowledge of healthcare programs and can be referenced as needed throughout your implementation process.
This document was finalized in May 2025. Information regarding CalAIM services is regularly being updated; referring to the Department of Health Care Services (DHCS) Enhanced Care Management & Community Supports Resources website is recommended to ensure you have the most up to date information.
If you would prefer to print out the toolkit, rather than navigate the website, click here.
Contents
Section 1: Background Information on Medi-Cal and CalAIM
Learn about California's Medicaid program serving 15 million Californians, the CalAIM reform initiative, and how the service delivery model works through Managed Care Plans (MCPs).
Section 2: Information on ECM, Community Supports, and Community Health Workers
Explore Enhanced Care Management for high-need populations, Community Supports services like housing assistance, and the Community Health Worker benefit that can directly support domestic violence survivors.
Section 3: Closed Loop Referral Requirements
Understand the requirements for tracking referrals, supporting members through the referral process, and monitoring outcomes to ensure connections to needed services.
Section 4: Credentialing and Contracting
Learn how to identify MCPs in your area, obtain a National Provider Identifier (NPI), approach MCPs for contracting opportunities, and navigate the credentialing process.
Section 5: Infrastructure and Administrative Support Options
Discover options for building internal infrastructure or partnering with third-party administrative organizations, and considerations for selecting Electronic Health Record systems.
Section 6: Understanding Confidentiality and Consent Requirements
Learn strategies for balancing HIPAA requirements with domestic violence confidentiality standards, including consent management and documentation protocols.
Understand the data collection requirements for ECM and Community Supports, including member demographics, service documentation, and reporting methods.
Section 8: Billing and Reimbursement
Learn about billing options including claims, CMS-1500 forms, or invoices, and understand the ecosystem of EHRs, clearinghouses, and MCPs in the reimbursement process.
Section 9: Quality Oversight and Monitoring
Understand MCP oversight processes, documentation requirements, and strategies for addressing confidentiality concerns within quality monitoring.
Section 10: Accessing Support for CalAIM Implementation
Discover resources including Collaborative Planning Initiatives, the Technical Assistance Marketplace, MCP support, and potential Incentive Payment Program funding.
Section 11: Policy Considerations
Explore policy approaches for balancing healthcare integration with confidentiality requirements, including HMIS-inspired models and confidentiality-preserving data systems.