CONNECTING MEDI-CAL
MEMBERS TO CARE, SUPPORT, &
COMMUNITY-BASED SERVICES
Bridging the gap between healthcare and
community support to help Medi-Cal members
get the care and services they need.
WHAT IS CalAIM PROGRAM?
California Advancing and Innovating Medi-Cal, commonly known as CalAIM, is California’s initiative to transform the Medi-Cal system into a more coordinated and person-centered healthcare program.
CalAIM recognizes that good health involves more than medical care. Housing, nutrition, personal care, transportation, social support, and a safe living environment can all have an important impact on a person’s overall health and well-being.
Through CalAIM, Medi-Cal managed care plans may offer Community Supports to eligible members as medically appropriate and cost-effective alternatives to traditional healthcare services or settings.
Some Community Supports can help individuals:
- Transition from a nursing facility to a community setting
- Avoid unnecessary institutionalization
- Transition or divert to an assisted living facility
- Receive personal care and homemaker services
- Obtain assistance with housing
- Receive medically tailored meals or medically supportive food
- Access home modifications
- Receive recuperative care following hospitalization
- Receive respite services
- Receive assistance addressing other health-related social needs
Community Supports are available to eligible Medi-Cal members, but not every Medi-Cal managed care plan offers every Community Support. Availability depends on the member’s health plan, county, eligibility, and the plan’s authorization requirements.
CalAIM Community Supports & Assisted Living
One of the Community Supports approved by the California Department of Health Care Services (DHCS) is:
Nursing Facility Transition/Diversion to Assisted Living Facilities
This service is designed to help eligible Medi-Cal members transition from a nursing facility to an assisted living environment or avoid admission to a nursing facility when assisted living may safely meet their needs.
Depending on eligibility and authorization, this support may help individuals access a more community-based living environment while receiving services appropriate to their needs.
Eligible assisted living settings may include residential care environments such as:
-
- Residential Care Facilities for the Elderly (RCFEs)
- Adult Residential Facilities (ARFs)
- Other settings permitted under the applicable Community Supports benefit
The goal is to support individuals in receiving appropriate care while promoting independence, dignity, safety, and community living.
DHCS identifies Nursing Facility Transition/Diversion to Assisted Living Facilities as one of its pre-approved Community Supports.
WHO MAY QUALIFY?
Eligibility for CalAIM Community Supports is determined by the individual’s Medi-Cal managed care plan and the specific Community Support being requested.
You or your loved one may be eligible if you:
-
- Are enrolled in Medi-Cal
- Are enrolled in a Medi-Cal managed care plan that offers the applicable Community Support
- Have health or functional needs that may be addressed through the requested service
- Meet the managed care plan’s eligibility and authorization criteria
- May benefit from receiving services in a community-based setting
- Are at risk of institutionalization or require assistance transitioning from a higher level of care, when applicable
Some Community Supports have additional eligibility requirements.
Being enrolled in Medi-Cal does not automatically guarantee eligibility for every CalAIM Community Support. The member’s managed care plan determines whether the service is available and whether the member meets the applicable criteria.
Our team can help you understand the process and identify the appropriate next steps.
How CalAIM Can Support Individuals & Families
CalAIM takes a broader approach to care by recognizing that individuals may need support beyond traditional medical services.
COMMUNITY-BASED CARE
CalAIM Community Supports can help eligible members access services that allow them to remain in or transition to a community-based environment when appropriate.
SUPPORT WITH DAILY LIVING
Certain Community Supports may provide assistance with personal care, homemaking, and other daily living needs.
ASSISTED LIVING TRANSITIONS
For eligible members, Nursing Facility Transition/Diversion to Assisted Living Facilities may support a transition from institutional care or help prevent unnecessary institutionalization.
CARE COORDINATION
Enhanced Care Management provides eligible members with a Lead Care Manager who helps coordinate health and health-related services across different providers and settings.
ADDRESSING SOCIAL NEEDS
CalAIM Community Supports may also address needs related to housing, nutrition, home accessibility, recuperative care, and other factors that can affect health and well-being.
Choosing the right care setting for a loved one can be overwhelming. Families may be trying to determine whether their loved one can safely remain in the community, transition out of a nursing facility, or receive additional support with daily activities.
CalAIM provides another pathway for eligible Medi-Cal members to access community-based services that may help support their health and independence.
A PERSON-CENTERED APPROACH
CalAIM is designed around the individual’s needs rather than focusing solely on medical treatment.
COMMUNITY-BASED SUPPORT
The program emphasizes services that can help eligible members live safely and successfully in the community.
COORDINATED CARE
Eligible members receiving Enhanced Care Management may have access to a Lead Care Manager who helps coordinate healthcare and health-related services.
SUPPORT FOR FAMILIES
Understanding Medi-Cal programs and managed care benefits can be complicated. Our team can help families understand the available options and identify the appropriate next steps.
WHY FAMILIES EXPLORE CalAIM SERVICES
OUR CalAIM SUPPORT PROCESS
FREQUENTLY ASKED QUESTIONS
Is CalAIM the same as the Assisted Living Waiver (ALW)?
No. CalAIM and the Assisted Living Waiver are separate Medi-Cal programs and benefit structures.
The ALW is a specific Home and Community-Based Services waiver administered by the California Department of Health Care Services.
CalAIM Community Supports are services offered through participating Medi-Cal managed care plans and may include Nursing Facility Transition/Diversion to Assisted Living Facilities.
Does every Medi-Cal member automatically receive CalAIM Community Supports?
No. Community Supports are optional services offered by Medi-Cal managed care plans. Plans determine which services they offer and establish applicable eligibility and authorization requirements.
Can CalAIM help someone transition from a nursing facility?
Potentially, yes. One of the pre-approved Community Supports is Nursing Facility Transition/Diversion to Assisted Living Facilities. Eligibility and authorization depend on the individual’s circumstances and managed care plan.
Can CalAIM help someone avoid nursing facility placement?
The individual’s managed care plan determines eligibility and authorization.
Does CalAIM pay for assisted living?
Coverage depends on the specific Community Support, the member’s Medi-Cal managed care plan, authorization, and applicable program requirements.
Room, board, and other costs may be treated separately and should be confirmed with the member’s health plan and care team.
Can someone receive CalAIM services if they already live in the community?
The specific service and eligibility requirements will depend on the member’s managed care plan.
How do I find out which Community Supports are available?
HELPFUL RESOURCES & SOURCES
California Department of Health Care Services – CalAIM
Learn more about California’s CalAIM initiative and its goals:
California Advancing and Innovating Medi-Cal (CalAIM) – DHCS
CalAIM Enhanced Care Management & Community Supports
Official information regarding Enhanced Care Management and Community Supports:
Community Supports Search Tool
Use the official DHCS search tool to determine which Community Supports may be available through a Medi-Cal managed care plan:
Community Supports Policy & Resources
Access official DHCS policy guidance, implementation resources, and current Community Supports information:
Medi-Cal
Access official DHCS policy guidance, implementation resources, and current Community Supports information:
Assisted Living Waiver (ALW)
For families considering the Assisted Living Waiver as another Medi-Cal-supported pathway:
California Department of Aging
CONTACT
OUR TEAM
If you have questions regarding
the ALW Program, assisted living
options, or eligibility requirements,
our team is here to help.
Important Information
CalAIM Community Supports are not guaranteed benefits for every Medi-Cal member. Services are optional for Medi-Cal managed care plans to offer, and eligibility, medical appropriateness, authorization, and availability may vary by managed care plan and county.
For the most current information regarding available services and eligibility, families should confirm benefits directly with the member’s Medi-Cal managed care plan and/or the California Department of Health Care Services.
QUESTIONS ABOUT CALAIM AND COMMUNITY SUPPORTS:
California Department of Health Care Services
CalAIM ECM & Community Supports: CalAIMECMILOS@dhcs.ca.gov
Our Team: 213-478-0800