Meeting the Mandates: Powering California HRSN Service Delivery
The clock is ticking. By July 1, 2025, Managed Care Plans (MCPs) must implement Closed-Loop Referral System (CLRS) requirements for California HRSN service delivery as part of CalAIM. These new mandates aren’t just about compliance; they’re about improving member outcomes by ensuring referrals don’t fall through the cracks.
At Findhelp, we’ve been supporting MCPs from the start of CalAIM, continuously enhancing our platform to keep pace with evolving requirements. We’re ready to help you stay ahead of the deadline—ensuring smooth, efficient implementation before the July 1 readiness milestone.
Read on to learn:
- What is CalAIM?
- New requirements for 2025: how we can help MCPs meet California HRSN service delivery mandates
- Successful case studies from Health Net and Blue Shield of California’s Promise Health Plan
- The future of Findhelp’s ongoing support for California organizations across industries
CalAIM: California Advancing and Innovating Medi-Cal
Section 1115 of the Social Security Act gives states flexibility to design and improve their Medicaid programs by providing waivers authorizing experimental, pilot, or demonstration projects. These projects are often focused on addressing Medicaid enrollees’ unmet health-related social needs and downstream health impacts.
On January 1, 2022, the California Department of Health Care Services (DHCS) launched the California Advancing and Innovating Medi-Cal (CalAIM):
- CalAIM is a five-year plan to make Medi-Cal more equitable, coordinated, and person-centered, steered by the Population Health Management Policy Guide
- It focuses on addressing complex care for high-needs populations, such as individuals experiencing homelessness, serious mental illness, or substance use disorders, or children involved in the child welfare system
- Designated navigators coordinate members’ physical and behavioral care, as well as access to critical social services
Through services such as Asthma Remediation and Housing Navigation Support, CalAIM encourages Medi-Cal managed care plans to address social determinants of health (SDoH) and offer preventative upstream interventions.
What’s changing in 2025?
New requirements demand that MCPs and providers track and verify social care referrals while exchanging real-time data to improve care coordination.
- More Service Categories: DHCS has expanded the number of referral categories requiring closed-loop tracking.
- Stronger Referral Accountability: MCPs must track, support, monitor, and verify that referrals result in a Known Closure—ensuring members actually receive the services they need.
- New Data Collection Requirements: MCPs must report specific referral data, requiring seamless technology to capture, manage, and analyze this information.
How Findhelp helps health plans succeed
Findhelp is already positioned to help California meet these goals—connecting millions to essential services while ensuring every referral is accounted for. As the State moves to strengthen its health and social care integration, we’re stepping up to power the state’s latest closed-loop referral (CLR) and data-sharing initiatives.
- Turnkey CLR Compliance — Our platform is built to handle eligibility verification, referral tracking, and Known Closure reporting, ensuring you meet every CLR requirement.
- Seamless Integration — Works with your existing systems, minimizing disruption while maximizing efficiency.
- Proven CalAIM Expertise — We’ve been at the forefront since day one, refining our platform based on real-world MCP needs.
- Data Capture and Reporting — Out-of-the-box reports capture dedicated fields for required data elements and minimum data set (including closed-loop referral status), and data warehouse connections support custom reports.
Findhelp’s Comprehensive CalAIM Workflow
Our platform supports flexible workflows based on your preferences and system of record. First, member eligibility and service eligibility are verified. Then, referrals are made for authorized services to contracted providers, who share data, outcomes, and invoices back to the managed care plan.
Real results from California customers
Findhelp partners with MCPs across the state to support California HRSN service delivery. We enable MCP staff and Enhanced Care Managers (ECMs) to confirm eligibility and order more than 445 different social services from community partners. Through the Findhelp platform, ECMs and other Navigators assess members and order services based on state-mandated eligibility criteria, and contracted providers bill and receive payments for their services.
Health Net
Health Net works with Findhelp to manage their Community Supports (CS) Provider referrals and Enhanced Care Management (ECM) workflows. Their CalAIM platforms allow for end-to-end referrals in tandem with existing workflows in their internal care management system and provider portal.
Health Net has a mixed workflow: ECM checks Findhelp for eligibility using our eligibility search functionality, powered by Health Net’s roster file, and CS Providers navigate people to services using the Findhelp network.
Findhelp onboarded more than 150 of Health Net’s CS Providers to accept and respond to referrals. We work with Health Net’s staff and contracted ECM providers to provide ongoing training, office hours, and general support:
Hosted in-person events as well as virtual sessions
Send quarterly newsletters to CS Providers
Survey CS Providers to seek feedback
Blue Shield of California’s Promise Health Plan
Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering Medi-Cal plans. In support of CalAIM, they’re focusing on community county social service agencies and county First 5s.
Blue Shield California partners with Findhelp to implement CalAIM referrals in LA County:
Prioritizing community engagement and partnerships
Findhelp integrations with their care management system and provider portal
Closed-loop referrals to county-based programs, in tandem with existing workflows
Trusted by California organizations the state
More than 80 health plans, health centers, hospital systems, nonprofits, employers, government agencies, and educational institutions around the state partner with Findhelp as a trusted social care vendor.
Future proofing your CalAIM strategy with Findhelp
The CalAIM landscape is evolving, and so is our platform. We are continuously expanding our capabilities to keep pace with state policy updates—so you can stay compliant, streamline operations, and deliver better care. Here’s how we’re enhancing our support to make CalAIM compliance easier than ever:
Claims & Reimbursement Workflows
Managing CalAIM Community Supports & ECM reimbursements just got easier. Our new claims and reimbursement workflow ensures seamless payment processing for contracted providers:
Seamless Integrations & APIs
We’re building stronger connections between MCPs, providers, and technology platforms to enhance care coordination and close referral loops faster:
- TruCare & Salesforce Integration – Streamline workflows by syncing with leading care management systems.
- HarmonyHealth Text Messaging – Direct seeker outreach via SMS helps engage individuals and increase referral closure rates.
- Expanded Eligibility APIs – Reduce manual work for MCPs and contracted providers with automated eligibility verification and file ingestion.
Don’t Wait—Stay Ahead of the Deadline
The new CLR mandate is an opportunity to enhance care coordination and health outcomes—but only if you have the right technology and workflows in place. With Findhelp, you’ll not only meet compliance requirements but also drive better health outcomes for Medi-Cal.
We’re committed to keeping you ahead of regulatory changes while making CalAIM implementation as seamless as possible. Whether it’s reimbursement processing, referral tracking, or system integrations, Findhelp has the technology and expertise to support your success.
Schedule a demo with us to see how we can partner with your organization to support members through CalAIM.
