MedicaidDocumentationHigh impact
26-749 CalAIM PHM Update: New Requirements for Pregnancy Care, IHAs and Care Coordination
Health Net·CA · OB-GYN, Family Medicine, Internal Medicine·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
CalAIM Population Health Management policy expands care coordination requirements for pregnancy/postpartum care, Initial Health Appointments, and discharge planning. Starting July 1, 2026, all pregnant and postpartum patients must receive moderate or high-intensity care coordination with comprehensive risk assessments and individualized care plans.
Action Required
Immediately through June 30, 2026: 1) Respond promptly to all Plan outreach for pregnancy/postpartum support and discharge follow-up 2) Fax discharge information with instructions and medication details to 844-989-1935 (do not mail) 3) Submit IHA results within 90 days of member enrollment 4) Document IHA exceptions when using prior records. By July 1, 2026: Implement comprehensive risk assessment tools comparable to ACOG/CPSP standards for all pregnant/postpartum members at early prenatal visits, each trimester, and postpartum visits. Develop individualized care plans including obstetric, nutrition, psychosocial interventions. Ensure all pregnancy/postpartum patients receive moderate or high-intensity care coordination.