California’s healthcare landscape is undergoing a significant transformation with the integration of Community-Based Care Management into Dual Eligible Special Needs Plans (D-SNP) under the CalAIM initiative. The shift aims to enhance care coordination for individuals eligible for both Medicare and Medi-Cal, aligning with the principles of Value-Based Care (VBC).

What is CICM?
California Integrated Care Management (CICM) refers to the California-specific requirements for integrated care coordination for specific vulnerable populations covered by D-SNP plans as determined by the state. Federal guidelines dictate that robust care coordination be provided to members – CICM adds an additional layer of state -specific requirements. These 2026 requirements are a replacement to the 2024 California ECM-like care management mandates.

This program emphasizes the importance of DSNP Health plans contracting with Community Based Organizations (CBOs) that service CICM populations. This collaboration aims to augment plan-based care management, ensuring that members receive coordinated and comprehensive services. Meaning, when a CBO assigns a Care Manager to a member, the D-SNP Care Manager must directly communicate with the CBO Care Manager to ensure that the member receives holistic and comprehensive care.
CICM is county-driven, community-rooted and designed to engage hard to reach populations through trusted Community Based Organizations (CBOs), especially those disconnected from traditional care.

Who is eligible?
DHCS requires that all DSNP Health Plans provide CICM for the following vulnerable adult populations:

• Homeless
• At risk for ED use and rehospitalization
• Serious Mental Health or Substance Use Disorder
• Those transitioning from incarceration
• Those at risk for long term care
• Transitioning from nursing home to community
• Pregnant/postpartum and at risk for racial/ethnic disparities
• Those with documented dementia needs

What are the benefits of CICM?
From a value-based care perspective, integrating CICM into D-SNPs offers several key benefits. It enhances care coordination by fostering seamless communication between healthcare providers and community-based organizations, reducing service fragmentation and redundancies. This model also strengthens the ability to address social determinants of health – such as housing, nutrition, and transportation – which are critical to improving overall well-being. By developing individualized care plans that incorporate both medical and social needs, CICM supports better chronic condition management, reduces hospital readmissions, and improves health outcomes. Additionally, this approach promotes cost efficiency by prioritizing prevention and minimizing avoidable high-cost services, aligning closely with the goals of value-based care.

What sets this apart from Traditional CM programs?

1. Formal Partnership with Community Based Organizations
2. Dual Care Management Coordination
3. Whole-Person Care Approach
4. Emphasis on High-risk, High-Need Populations
5. Integrated into D-SNP Requirements

A critical moment for Health plans – Are you ready?
California’s move to integrate CICM into D-SNPs under the CalAIM framework marks real progress towards a more integrated, value-based healthcare system. This shift presents an opportunity; not all are prepared for. Those that lag risk falling behind as regulatory expectations rise and member expectations evolve. The message is clear- readiness isn’t optional; it’s a strategic advantage.

For more information about integrating CICM into D-SNPs, reach out to COPE Health Solutions at info@copehealthsolutions.com.