CalAIM Care Management
Whole-Person Support for Medi-Cal Patients
At St. John’s Community Health, we’re proud to be a partner in California’s innovative CalAIM initiative—designed to improve health outcomes and reduce disparities by supporting the full picture of your health.
Our CalAIM Care Management services provide personalized, wraparound support to help Medi-Cal members navigate complex medical, behavioral, and social needs. We meet you where you are—with care that extends beyond the exam room.
What Is CalAIM?
CalAIM (California Advancing and Innovating Medi-Cal) is a statewide program focused on delivering more coordinated, person-centered care—especially for people with chronic conditions, mental health needs, or housing challenges.
Enhanced Care Management
Enhanced Care Management (ECM) is person-centered care management provided to the highest-need Medi-Cal enrollees, primarily through in-person engagement. ECM will address clinical and non-clinical needs of patients through intensive coordination of health and health-related services. The ECM benefit assigns each patient a Lead Care Manager (LCM) to provide intensive whole-person care management to help address patient needs. This benefit ensures that patients are engaged with a LCM who understands their goals, develops a plan in partnership with the patient and their providers, and actively connects them with services and resources that help them meet those goals.
Chronic Health Condition Education
Referral to Community and Social Support
Hospital Discharge Coordination
Preventive Care Referral Follow Up
Medication Education
Treatment Adherence Monitoring
Community Supports
Community Supports are cost-effective, health-supporting, and typically non-medical activities. St. John’s Community Health offers: Housing Transition and Navigation Services, Housing Tenancy and Sustaining Services, & Asthma Remediation. Patients receiving Community Supports at St. John’s Community Health are connected with a Housing Care Manager (HCM) who provide homeless and housing support services to help patients find appropriate housing, connect them with emergency shelters, and identify short- and long-term housing goals.
Housing Transition Navigation Services: Assistance with finding and securing safe and stable housing
Housing Tenancy and Sustaining Services: Support in maintaining safe and stable tenancy once housing is secured
Asthma Remediation: Assistance providing information to members about actions to take around the home to mitigate environmental exposures that could trigger asthma symptoms and remediation’s designed to avoid asthma-related hospitalizations. (Anthem Blue Cross only currently)
California Advancing and Innovating Medi-Cal (CalAIM) Program
To be eligible for CalAIM, patients must be enrolled in Medi-Cal Managed Care with Anthem Blue Cross, Health Net, or L.A. Care and meet the criteria that the Department of Health Care Services (DHCS) requires in each population of focus.
Please fill out this form to learn more about our CalAIM program or call 323-541-1411