Are you a Community Based Group looking to bill MediCal?
Community based organizations or CBOs have been providing essential care for years, now they are being integrated into the California Medicaid program (MediCal), and getting certified is easier than it may seem.
California’s CalAIM waiver has opened the door for community based organizations (CBOs) to begin billing the state’s Medicaid program (Medi-Cal) for the valuable services they provide. Beyond extensive care coordination services (known as “Enhanced Care Management” or ECM) the program allows CBOs to bill for various Community Supports (CS) that include services around housing, medically tailored meals, respite services, sobering centers, and others.
🔆CalAIM (California Advancing and Innovating Medi-Cal) is a statewide initiative aimed at transforming the Medi-Cal system by providing more comprehensive care through coordinated services, especially for vulnerable populations. It focuses on addressing social determinants of health and improving health outcomes by integrating medical, behavioral, and social support services.
This is an incredible evolution in the Medicaid system. It is putting CBOs in the primary pathway of care delivery. Its investing in the “upstream” services that we know will lead to healthier lives and less dollars spent on otherwise avoidable healthcare.
If you are a CBO and you’re looking to get involved (which you really should be, its good for those you serve, its good for Medi-Cal and its probably good for your organization), what does this require? Build a revenue cycle!
Most CBO’s that are performing services for Medi-Cal members now don’t really have to change the way they deliver those services to start getting paid by Medi-Cal. What you may have to do is update the way you capture the information that proves the service was provided in order to generate a bill or “claim”. It is not as complicated as it seems and there are lots and lots of resources to assist you.
Before you get started, its important to answer three primary questions:
- What services can your organization delivery to Medi-Cal members that aligns with either ECM or CS?
- What could it cost your organization to deliver those services?
- How do you plan to document what your organization has done and submit a bill so you can get paid?
We built a tool that we think can help answer the first two questions. Take a quick peek at it, fill out what you can and see if providing Enhanced Care Management (ECM) or Community Supports (CS) is right for your organization. We’re constantly refining it, so if something doesn’t make sense or you spot a bug: let us know!
Try out the tool and tell us if it works!
We’ve helped many CBO’s across the state to take the simple steps necessary to begin billing for ECM and CS services.
Its a worthwhile investment, it can diversify your funding source, it can help you oversee the care that is vital to the health and well being of those you serve - and there are lots and LOTS of resources available to help get you across the finish line.
Please let us know if you need any assistance, (we’re at hello@thehealthcolab.com) and we’re here to help!
Articles by
Aaron Holman
The Health Co-Lab, a Service-Disabled Veteran-Owned Small Business, is a collaborative space dedicated to tackling the toughest challenges in healthcare with practical, value-driven solutions for all stakeholders.