Refer Members to Community Supports Services (CalAIM) — Coverage Criteria
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Guidance for referring Medi-Cal members to Community Supports (CS) services under California's CalAIM program; intended for providers and care coordinators who determine eligibility and refer members to CS services.
No material clinical or coverage changes in this revision.
Community Supports — Coverage Criteria
Housing Transition & Tenancy Services
Covered when members meet service-specific eligibility criteria listed below
Housing navigation and tenancy services assist obtaining and maintaining housing; deposits available when county resources are exhausted.
Recuperative and Short-term Post-hospital Services
Recuperative services eligibility
Used for beneficiaries exiting hospital who do not need inpatient care.
Eligibility includes exiting recuperative care or being post‑hospitalization and meeting the HUD definition of homeless.
Eligibility: beneficiary lives in the community with compromised activities of daily living and requires caregiver relief to avoid institutional placement.
Eligibility: individuals age 18+ who are intoxicated and are transported to or present at an emergency department or a jail.
Home-like setting supports (e.g., asthma remediation, meals, transitions, personal care)
Long‑term well‑being in home‑like settings — eligibility varies by service
Eligibility requires poorly controlled asthma in the past 12 months.
Eligibility: experiencing homelessness; OR exited homelessness and entered housing in the last 24 months; OR at‑risk of homelessness or institutionalization whose housing stability could be improved.
Eligibility: at‑risk for institutionalization in a nursing facility.
Eligibility: has chronic conditions AND is discharged from hospital or skilled nursing facility, or is at high risk of hospitalization, nursing facility placement, or requires extensive care coordination.
Eligibility: resident of nursing facility for 60+ days, willing/able to reside safely in assisted living or home with supports, and currently receiving necessary nursing facility services or meet minimum NF criteria.
Eligibility: at‑risk for hospitalization or institutionalization in a nursing facility; OR individuals with functional deficits and no other support system.
Housing deposits under Community Supports are available only when there is an identified need and all county resources have been expended. Providers should confirm members are receiving housing navigation or tenancy services and that local county supports have been fully explored before arranging a housing deposit.
What Providers Must Do
Use eligibility criteria to determine coverage
Use the eligibility criteria in this policy to determine whether a Community Supports service is covered for a member and, when appropriate, refer the member to the designated CS service (for example, housing navigation, tenancy services, or housing deposit).
- Apply the service‑specific eligibility rules (e.g., HUD definition of homeless or receipt of housing resources through local Coordinated Entry System for Housing Deposit).
- Refer members to the appropriate CS service described in this document when eligibility is met.
Step therapy not specified
This policy does not specify any step therapy requirements for Community Supports services.
Referral support contacts
For assistance with CS program information or to access services, contact Health Net or the State Medi‑Cal Health Care Options.
- Health Net: 800-675-6110
- State Medi‑Cal Health Care Options: 800-430-4263 (TTY: 800-430-7077)
Eligibility‑dependent denials
Referrals or coverage may be denied if the member does not meet the service‑specific eligibility criteria (for example, not meeting the HUD definition of homeless for Housing Deposit).
- Housing Deposit is available only if the member receives housing resources through the local Coordinated Entry System or meets HUD homeless definition or is at‑risk of homelessness.
- Housing deposits are available only when all county resources have been expended.
Background and Program Context
Community Supports (CS) under CalAIM are a set of targeted services administered to address social drivers of health and reduce acute care utilization for Medi‑Cal beneficiaries. CS include services such as housing supports (navigation, tenancy, deposits where county funds are exhausted), recuperative and short‑term post‑hospital services (medical respite, short‑term post‑hospital housing, sobering centers), and home‑based supports (environmental adaptations, asthma remediation, medically tailored meals, personal care and homemaker services).
For referrals and assistance accessing CS, contact Health Net at 800‑675‑6110 or the State's Medi‑Cal Health Care Options at 800‑430‑4263 (TTY: 800‑430‑7077).
Key Definitions
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