CalAIM, a broad alteration of Medi-Cal, eliminates choice for the people who need it most
As a two-time liver transplant recipient and cancer survivor, I’ve spent much of my life navigating California’s health care system, relying on trusted doctors, coordinated care, and a health plan that understands my needs. I’m also a dual-eligible Californian — someone who qualifies for both Medicare and Medi-Cal — which is why open enrollment is such a pivotal time. Determining plan options is what determines my costs and available services for the rest of the year.
Unfortunately, this year is going to be even more challenging because of CalAIM — a broad alteration of Medi-Cal that the Department of Health Care Services (DHCS) claims will simplify care but instead eliminates choice for the people who need it most.
With growing uncertainty about what the future of Medicare and Medicaid will look like in the coming years, and significantly less federal funding flowing to states like ours, we must ask the hard questions. Is now really the time to charge ahead with massive changes to Medi-Cal? When Washington is rethinking how these programs are financed, California should be focused on the immediate impact to patients and how we mitigate future funding challenges.
Instead, CalAIM is plowing ahead with changes that will severely impact patient access and care. Starting next year, CalAIM will only allow one commercial Medicare-Medi-Cal plan in many counties. For the 1.7 million Californians who, like me, qualify for both programs, this means we will only have a single option for a health insurance plan. Rather than being afforded a choice among several plans like most seniors during this year’s open enrollment, CalAIM is unintentionally creating a two-class system that forces dual-eligible Californians into restricted plan options, while straight Medicare enrollees continue to enjoy real choice.
On paper, the state’s plan may sound efficient. In reality, it’s leaving Californians behind. Many integrated Medicare-Medi-Cal plans, often called Dual Eligible Special Needs Plans (D-SNPs), are specifically designed to coordinate benefits and services for people with the most complex medical, behavioral, and social needs. These plans help manage medications, connect patients to housing or food assistance, provide dental care, offer transportation, and ensure that multiple health care providers adequately communicate with one another. Narrowing participation to one or two plans per county doesn’t streamline care — it severs existing relationships that have kept vulnerable Californians healthy and stable.
Particularly for those living with hepatitis, a lack of quality plan options is even more alarming. Our state has been a national leader in testing and treating hepatitis C, but that may no longer be the case. The bucket of money allocated to Medi-Cal for hepatitis C treatment has already been cut roughly in half compared to previous years, and it could shrink even further every year thereafter.
As someone who directly coordinates my own health care with multiple providers and also serves on the community advisory committee for the Partnership Health Plan of California, I’ve seen what happens when care is disrupted and patients can no longer go to the doctor they trust. I might even be in that boat soon, since Partnership’s D-SNP won’t be ready to roll out in 2026, leaving Kaiser as our only D-SNP option in Sonoma County until 2027. Not because other plans failed or because Kaiser receives the best ratings, but because the state decided it was easier to manage fewer options.
That’s not reform, it’s denial of care. And, with minimal communication from DHCS about these changes, it feels like the very people CalAIM was meant to help are being boxed into one-size-fits-all coverage that ignores local realities.
Not only will care be disrupted, but costs will likely increase and quality will be pushed to the back burner. A recent issue brief highlighted this — restricting competition among health plans leads to higher costs, reduced innovation, and worse outcomes. The evidence is clear: When plans compete, patients win — through better access, more responsive services, and real accountability. When competition is removed, the incentive for plans to do better is also removed.
Fixing CalAIM won’t happen in isolation. Policymakers need to keep pushing, and stakeholders must continue working together to make our system stronger. If we stay at the table, amplify patient voices, and lead with compassion, California can once again set the standard — not by limiting choices, but by expanding access and rebuilding trust in a health care system that puts people first.
In the short-term, DHCS should open access to more D-SNPs and allow qualified, high-performing plans to continue serving our state’s most vulnerable patients. Dual-eligible Californians — many living with serious or chronic illnesses — deserve the same freedom of choice that every other traditional Medicare beneficiary has.
Bill Remak, a Petaluma resident, is founder and CEO of the California Hepatitis C Task Force.