Nevada County officials say CalAIM ready to go live but billing, waivers and state reviews still unsettled

Officials told the Nevada County CCP on Jan. 8 that the county is technically approved to go live with CalAIM as of Nov. 1 but has not yet started billing because third‑party billing contracts and software integrations remain under negotiation.

A county representative described prolonged contract negotiations with a third‑party biller, saying the vendor revised terms after internal review and pushed back on pricing. County staff said they are negotiating a mix of flat fee and percentage payments to maintain vendor incentives to process claims efficiently.

Members described confusing and slow state review processes. One participant said multiple state reviewers had differing interpretations of application material (citing an example about a program element described as '7 b' not being read consistently across state reviewers). Others expressed concern about which CalAIM components depend on federal Medicaid waivers that may expire and how that could affect ongoing billing for jail‑based services.

Members also noted that law enforcement agencies that went live earlier often had public health or behavioral health partners managing CalAIM components, which may ease implementation; counties setting up CalAIM from scratch faced heavier administrative work. Staff said CalAIM allows a look‑back period for billing if the county finalizes the billing process soon, but the timeline remains uncertain.

No vote was taken; staff will continue negotiating billing contracts and report back with implementation timelines.