HIGHLIGHTS
- Under California Medicaid’s CalAIM program, community-based organizations can offer enhanced care management services.
- A nonprofit hired Abt to prepare them to become an enhanced care management provider.
- Abt delivered actionable recommendations, demonstrating a scalable approach to support Medicaid enrollment and participation for smaller providers.
PROJECT
CalAIM HIRE (Hub for Integration, Reentry, and Employment) Technical Assistance
The Challenge
California’s Medicaid program (Medi-Cal) introduced the California Advancing and Innovating Medi-Cal (CalAIM) initiative in 2021. This established Enhanced Care Management (ECM), a Medicaid benefit that provides coordinated care management for certain individuals with complex medical and social needs. The policy created new opportunities for community-based organizations to participate directly in Medicaid-funded care delivery.
However, many local providers lack experience operating within Medicaid managed care environments. They must navigate enrollment requirements, managed care contracting, compliance standards, and billing infrastructure while continuing to serve vulnerable populations.
Hub for Integration, Reentry, and Employment (HIRE), an Orange County nonprofit, had long supported previously incarcerated youth and adults through reentry and stabilization services. To participate in Medicaid-funded care delivery, HIRE needed to understand Medi-Cal requirements, contracting expectations with managed care, and the operational systems required to deliver and bill for ECM services.
The Approach
Abt applied a structured Medicaid readiness framework designed to help smaller and community-based providers adapt to changing delivery systems. Through document review and interviews with HIRE staff, managed care representatives, current ECM providers, and corrections partners, we developed:
- Health Plan Certification Review laying out key Medi-Cal and managed care requirements
- A Needs Assessment establishing operational, staffing, and infrastructure baselines
- Gap Assessment identifying areas of alignment and priority risks, including billing capacity
We translated these findings into clear action steps to close gaps and strengthen HIRE’s readiness to participate in Medicaid-managed care. Abt delivered findings in concise leadership-ready memos supported by a stoplight framework that enabled rapid decision making.
The Results
HIRE now has a clear and actionable roadmap for Medicaid participation. Leadership has visibility into operational strengths, compliance gaps, and infrastructure needs required for ECM enrollment. The organization is positioned to submit a competitive provider application and sustainably deliver Medicaid-funded care.
Beyond a single provider, this engagement demonstrates Abt’s ability to support smaller and community-based organizations as they adapt to Medicaid delivery system transformation. As CMS and states advance rural health and whole person care initiatives, scalable readiness frameworks like this one help providers navigate change, reduce risk, and expand access for underserved populations.
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