Over the past several years, organizations across California have invested significant time understanding CalAIM. Leaders have attended trainings, reviewed guidance, explored funding opportunities, and worked to determine how new models of care fit within their existing programs and services.

Through our work with counties, managed care plans, and community-based organizations across California, we have seen firsthand how much effort has gone into preparing for this transformation. Yet as implementation continues to mature, many organizations are finding themselves in a different phase of the conversation.
The challenge is no longer understanding what CalAIM is but rather translating its vision into day-to-day operations.

While policy provides direction, implementation requires organizations to determine how care coordination functions in practice, how information moves across systems, how partnerships are structured, and how new approaches to care can be sustained over time. These are often the questions leaders find themselves navigating long after the initial planning process has begun.

Looking Beyond Individual Programs

At its core, CalAIM was designed to transform Medi-Cal into a more coordinated, person-centered system that addresses physical health, behavioral health, and social needs together rather than separately.

This vision has introduced important opportunities through initiatives such as Enhanced Care Management (ECM), Community Supports, Population Health Management, and broader efforts to improve integration across systems. However, one of the realities organizations are discovering is that implementation extends far beyond any single program, contract, or funding stream.

Historically, many organizations have operated within clearly defined service areas and regulatory frameworks. CalAIM challenges organizations to think more broadly about how care is experienced across an entire continuum of support. For individuals and families navigating multiple systems simultaneously, outcomes are often shaped not only by the quality of services they receive, but by how effectively those services connect with one another.

As a result, successful implementation increasingly depends on an organization’s ability to coordinate across partners, align operational processes, and support a more integrated approach to care.

What We Are Seeing Across the Field

One of the most common themes emerging across implementation efforts is the gap between understanding policy and operationalizing policy.

Organizations may have a clear understanding of CalAIM requirements yet still face significant challenges when translating those requirements into workflows, partnerships, and sustainable operating structures. This is particularly true when implementation requires coordination across multiple organizations, funding systems, and stakeholder groups.

Through our work supporting organizations pursuing ECM and Community Supports opportunities, designing cross-system care pathways, developing data-sharing agreements, training care teams, and evaluating implementation efforts, we frequently encounter questions that are less about policy interpretation and more about operational readiness.

How should information move between partners? What processes support effective care coordination? How can organizations create consistency across teams while adapting to local needs? What structures need to be in place to support long-term sustainability?

These are not questions that can be answered through policy guidance alone. They require organizations to examine how systems function in practice and where opportunities for stronger alignment exist.

Readiness Is More Than Compliance

Much of the public conversation around CalAIM has understandably focused on requirements, contracts, documentation standards, and reimbursement structures. While these areas remain important, readiness often requires a broader perspective.

Organizations exploring ECM opportunities must evaluate staffing models, quality assurance practices, care coordination workflows, and data infrastructure. Community-based organizations must consider how their services integrate with managed care plans and existing systems of care. Counties and managed care partners continue working to strengthen collaboration, information sharing, and operational alignment across multiple stakeholders.

In many cases, the work of implementation is not simply about meeting requirements. It is about creating systems capable of supporting those requirements consistently and effectively over time.

Building Systems That Support Integration

One of the clearest lessons emerging from CalAIM implementation is that integration does not happen automatically. It requires intentional planning, ongoing collaboration, and operational structures designed to support coordination.

Across California, organizations are building cross-system care pathways, strengthening partnerships between managed care plans and community providers, developing data-sharing practices, training staff on documentation and equity measures, and evaluating outcomes to inform future improvements. While these activities may take different forms depending on the community or population being served, they all contribute to a shared goal: creating a more coordinated experience of care.

For many organizations, this work represents an ongoing process of refinement. As systems evolve, so too must the operational practices that support them.

Looking Ahead

CalAIM has introduced a significant shift in how care is envisioned across California’s Health and Human Services landscape. The vision is ambitious, and the work of implementation continues to evolve as organizations gain experience, strengthen partnerships, and refine their approaches.

Through our work across counties, managed care plans, and community-based organizations, we continue to see that successful implementation is rarely defined by policy knowledge alone. It is shaped by an organization’s ability to translate that knowledge into systems, processes, and partnerships that support coordinated care in practice.

As organizations continue navigating the next phase of CalAIM implementation, the opportunity is not simply to adopt new requirements. It is to build stronger, more connected systems capable of supporting the individuals, families, and communities they serve for years to come.