CalAIM budget estimator tool

A budget template for community-based organizations considering CalAIM contracting

Mar 25, 2024

Building the complex care field Care management & redesign Strengthening ecosystems of care Funding & financing

Background

The California Medicaid transformation effort known as CalAIM provides a tremendous opportunity for community-based organizations (CBOs) that provide social services to individuals with complex health and social needs. A key part of the transformation is the creation of new Medi-Cal benefits that CBOs are eligible to provide, including Enhanced Care Management and Community Supports, to serve specific high needs populations.

For many CBOs, considering a shift to incorporate Medicaid funded payments through contracts negotiated with managed care organizations (MCOs) can feel daunting. It requires the ability to project new sources of revenue and consider whether expected revenue will cover anticipated program expenses at start up and over time.

As part of CalAIM’s Providing Access and Transforming Health (PATH) initiative, the Camden Coalition is working with organizations in multiple counties as a technical assistance (TA) provider on the TA Marketplace and as a facilitator in the Collaborative Planning and Implementation (CPI) Initiative to expand the capacity and infrastructure of local services providers to successfully participate in transformation of the Medi-Cal delivery system.

Through this work, we heard from community-based providers that it is challenging to determine the business viability of becoming a provider of Enhanced Care Management and Community Supports.

As a nonprofit organization, we are keenly aware of the adage, “No margin, no mission.” Making a case for financial viability is a core competency of any organizational leader who wants to transform the delivery of services for people with complex health and social needs. This budget estimator is intended to serve as one of the tools in your toolkit to support informed discussions of future programming and the viability providing new Medi-Cal services.

What is the CalAIM budget estimator tool?

The CalAIM budget estimator tool is an Excel-based template that organizations can use to estimate costs and potential revenue associated with providing MediCal Enhanced Care Management and a sample of Community Support Services, including housing-related services and medically tailored meals.

The template includes built-in assumptions around payment structure for these services as described in the California Department of Health Care Services CALAIM Enhanced Care Management Policy Guide and Community Supports Policy Guide. The tool allows the user to account for organization-specific program expenses by inputting staffing costs, and other direct and indirect cost assumptions. Included within the template are generic rate ranges and input areas for customizing expected revenue sources which are used to calculate the program margin (ratio of revenue to expenses). A summary tab displays the projected margin by program year in order to help the user understand whether their current assumptions produce a fiscally viable program.

The CalAIM budget estimator is a resource you can use to model different scenarios for your program. This information can inform meaningful feasibility conversations with your Chief Financial Officer and other decisionmakers within your organization. It can also help to organize and elucidate critical information needed to justify your rate request to managed care organizations (MCOs) during contract negotiations.

Ready to start crafting your budget? Use the link below to download the budget tool.

Download the budget estimator tool in Excel format

Users are free to Share (copy and redistribute the material in any medium or format) and Adapt (remix, transform, and build upon the material) with attribution. You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license with no additional restrictions.

We are interested in learning how organizations and communities are using this tool. If you add to or build upon our budget estimator tool, we would love to hear from you. Please email us at [email protected] to share any updated versions, questions or requests for assistance.

Frequently asked questions

Who is this tool for?

This tool was designed for community-based organizations (CBO) in California who are curious about CalAIM as a potential revenue source for serving high-need/at-risk populations, as well as the expenses associated with start-up to provide these Medicaid services. Many CBOs are new to partnering with Medicaid managed care plans and are looking for information to help in their decision-making about whether participation as a contracted provider of CalAIM Enhanced Care Management and/or Community Support Services is right for their organization from a financial sustainability perspective.

With some adjustments, this tool can also be used by other entities such public agencies, individual healthcare practices, and other service providers.

What does this budget estimator tool offer that others don’t?

We have found that there are other calculators available that focus on the value proposition of providing social benefits, and tools that provide in-depth information for non-profit financing or specific sectors (linked in the Resource tab of the tool) but non that offer a simple way for organizations to take an initial look at whether CalAIM payments and related revenue sources will cover an organization’s expenses.