CalAIM 1115 Waiver Renewal Pending at CMS — ECM/Community Supports Funding on the Dec 31, 2026 Cliff
California's CalAIM 1115 waiver renewal application comment period closed March 12, 2026, with the existing waiver expiring December 31, 2026. CMS approval is pending — negotiations are expected to run through most of 2026, with a decision anticipated near the December 31 expiration.
Without renewal, the Enhanced Care Management (ECM), Community Supports, and CalAIM transformation funding stream disappears — threatening thousands of FQHC care coordination, CHW, housing navigator, and care manager positions. Combined with the December 2026 CR cliff for Community Health Center Fund ($4.6B/yr) and Health Resources and Services Administration appropriations, FQHCs face a structural dual December 2026 funding cliff.
Strategic implication for FQHC CFOs and program directors:
Key takeaways
- CalAIM 1115 waiver expires Dec 31, 2026 — CMS approval pending May–Aug 2026
- ~$1.2B/yr ECM + Community Supports funding at risk system-wide
- Pairs with $4.6B CHC Fund December 2026 CR cliff = dual federal December cliff
- CFOs: stress-test FY27 under 'no CalAIM' scenario and identify funded staff lines
Linked evidence
DHCS / CHCSSource packet
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FQHC Talent. (2026, May 12). CalAIM 1115 Waiver Renewal Pending at CMS — ECM/Community Supports Funding on the Dec 31, 2026 Cliff. Linked evidence: DHCS / CHCS. Retrieved September 11, 2026, from https://www.fqhctalent.com/intel/calaim-1115-waiver-renewal-cms-pending-may-2026
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