CalAIM’s Promise Is Right — But Community Providers Can’t Carry the Risk Alone
- Mystis Adult and Family SVCS
- 7 hours ago
- 3 min read
California’s CalAIM initiative was designed to transform care by addressing the social drivers of health, including housing instability. The vision is sound. The intent is strong.
But on the ground, many community-based providers are being asked to deliver that vision under conditions that are financially unsustainable and structurally misaligned.
This is not a failure of commitment. It is a rate adequacy and system alignment problem—and it threatens the long-term success of CalAIM itself.
Across California, community-based organizations (CBOs) are delivering core CalAIM services that make housing stability possible: Enhanced Care Management (ECM), personal care and respite, housing deposits, housing transition and tenancy-sustaining services, and Community Health Worker support. These services are foundational to whole-person care for individuals experiencing homelessness, justice involvement, and complex medical needs.
At Mysti’s Adult & Family Services, we provide these services across Monterey, Santa Cruz, San Benito, Merced, Contra Costa, and Los Angeles counties. This work is operational, not theoretical. It requires clinical staffing, compliance infrastructure, facilities, and constant coordination across housing, healthcare, and social service systems that were never designed to operate seamlessly.
That reality came into sharp focus in Monterey County, where we made the difficult decision to close a Community Supports–funded shelter.
The shelter did not close because the need disappeared. It closed because reimbursement rates failed to keep pace with the real cost of operating a medically safe, compliant, and humane program. During operations, dozens of individuals stabilized with us—many transitioning to permanent housing, long-term care facilities, or reconnecting with family. These outcomes mattered.
But Community Supports shelters must meet medical safety standards, habitability and building code requirements, staffing ratios, and regulatory oversight. As labor, insurance, utilities, food, and compliance costs rose, funding did not. Continuing would have required compromising standards or placing the organization at financial risk. Neither option was responsible.
At the same time, a different but related problem persists elsewhere.
In Contra Costa County, Mysti’s has active contracts and continues to provide ECM and Community Health Worker services. However, we do not have contracts for recuperative care or short-term post-acute placements—despite securing CA PATH grant funding to support the staffing required for those services.
The result is a paradox many providers recognize: capacity exists, staff are funded, and facilities are available—but without MCP authorization and contracting, services cannot be activated without placing the provider at financial risk.
This is not a readiness issue. It is a trust and alignment gap.
CalAIM asks CBOs to operate at the intersection of housing, healthcare, and social services—often absorbing the operational risk of system fragmentation.
Yet rates frequently fail to reflect true operating costs, contracting lags behind provider readiness, and responsible providers are penalized for refusing to subsidize underfunded care.
When community-based providers are forced to choose between mission and sustainability, the system itself becomes fragile.
If California is serious about CalAIM’s success, changes are necessary:
First, establish sustainable statewide rate adequacy that reflects the real cost of compliant, medically appropriate care.
Second, treat community-based providers as implementation partners—not stopgaps.
Third, stop shifting financial risk to organizations that do the work correctly.
This is not a call for blame. It is a call for alignment.
CalAIM’s vision is right. But vision alone does not stabilize housing, protect patient safety, or retain staff. Community-based providers are making CalAIM real every day. The system must now meet them halfway.
