The Four Stages of CalAIM Grief (and How to Navigate Them)

Launching a CalAIM program can feel overwhelming. At times, it may even feel like you’re doing something wrong—when in reality, you’re just doing something new.

Launching a CalAIM program can feel overwhelming. At times, it may even feel like you’re doing something wrong—when in reality, you’re just doing something new. Honestly, there is a lot to absorb in programs like Enhanced Care Management (ECM) and Managed Care Plans (MCP). One month you’re inspired, and the next you’re drowning in paperwork. At TRUE, we’ve walked alongside dozens of mission-driven organizations through this exact process. With a 95% success rate and over $1 billion secured in funding, we’ve seen the same emotional journey play out time and again.

We call it: The Four Stages of CalAIM Grief.

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Stage 1: Excitement

This is the honeymoon phase. You’re attending trainings, reading funding breakdowns, learning buzzwords like whole person care, and imagining a system where your organization can finally get paid for the work you’re already doing. It’s exciting—and it should be. CalAIM represents a rare funding stream. Unlike grants, Medicaid billing is fee-for-service, which means more financial flexibility and long-term sustainability.

Tip for this stage: Before diving in, capture the vision. Create a vision board showing how CalAIM could impact your community and organization. Share it with your team. When the hard days come, you’ll want to remember why you started.

Stage 2: Despair

This is when reality sets in. The contract process drags. Staff are overwhelmed. You’ve made hires, but you still haven’t billed a single dollar. Your board is pushing for progress while you’re buried in acronyms—SFTPs, RTF files, trackers, compliance reports, outreach logs. It feels like failure, but it’s not. Everyone experiences this stage. Everyone feels stuck here.

Tip for this stage: Break contracting into milestones.
For example:
Week 1: Submit documentation Week 2: Get your SFTP set up Week 3: Assign internal deadlines Celebrate the small wins. Don’t try to eat the whole elephant—just take the next right bite.

Stage 3: Hope

Finally, things start to click. Systems come online. Referrals begin. Your team finds its rhythm. Most importantly, you start seeing the real people this program was designed to serve. You may not be breaking even yet, but you’re gaining traction—and breathing easier.

Tip for this stage: Join a peer network of providers. Others have figured this out, and some are right where you are. In California, the CPI Collaborative Group Meetings are a great way to get tips, build relationships, and avoid reinventing the wheel.

Stage 4: Success

The machine is running. You’re billing Medicaid, delivering services, and changing lives. Yes, policy changes and unknowns still exist, but your foundation is solid. Now it’s time to move from reactive to strategic.

Tip for this stage: Document your wins. Track patients served, income generated, and impact made. Share these results with your board and funders, then refine your program for scale.
This is the moment when you shift from barely keeping up to planning your next big move.
You’re Not Behind—You’re Right on Time

If you’re in the middle of launching CalAIM and it feels overwhelming, know this: you’re not behind, and you’re not alone. The four stages are unavoidable—but with the right tools and support, you can walk through them and come out stronger on the other side.

At TRUE, our mission is to equip leaders like you to succeed in CalAIM and beyond. If you found these insights helpful, stay connected for more resources to support your funding journey.

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