CurrentHealth NetPolicy N/A

Community Supports (CalAIM) — referral and eligibility quick reference

Describes the 14 Community Supports services available to California Medi‑Cal members under CalAIM, with eligibility criteria and referral guidance for Health Net providers. Intended for providers and care managers making referrals to community support services in California.

Policy Summary

PayerHealth Net

PolicyCommunity Supports (CalAIM) — referral and eligibility quick reference

Policy CodePolicy N/A

Change TypeInformational

Effective DateN/A

Next Review DateN/A

Key ActionUse the service-specific eligibility criteria when referring Medi‑Cal members to Community Supports and document which criteria the member meets.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

14Community Supports services listed

CAState of applicability

800-675-6110Health Net contact phone

Community Supports — Eligibility Criteria (CalAIM)

General Eligibility for Community Supports

Services available to Medi‑Cal members through CalAIM; individual service entries list eligibility criteria.

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Housing Transition Navigation Services

Covered when ANY of the following are met:

ANY of the following

Receives housing resources through the local homeless Coordinated Entry System or similar system
Meets the Department of Housing and Urban Development (HUD) definition of homeless
At-risk of experiencing homelessness

Recuperative Care (Medical Respite) / Short-Term Post Hospitalization Housing

Covered when ALL of the following are met:

ALL of the following

Beneficiary no longer requires hospitalization but still needs to recover from injury or illness (medical respite)
Exiting recuperative care or at-risk of hospitalization or are post-hospitalization (for short-term post-hospitalization housing)
Meets HUD definition of homeless (for short-term post-hospitalization housing)

Asthma Remediation

Covered when ALL of the following are met:

ALL of the following

- Evidence of poor control (any)
  - An emergency department visit
  - Hospitalization
  - Two sick or urgent care visits
  - Asthma Control Test score of 19 or lower<= 19

Meals / Medically Tailored Meals

Covered when ALL of the following are met:

ALL of the following

Member has chronic conditions
- And any of the following
  - Discharged from the hospital or skilled nursing facility
  - At high risk of hospitalization, nursing facility placement, or extensive care coordination needs

Nursing Facility Transition / Diversion to Assisted Living / Community Transition Services

Covered when ALL of the following are met:

ALL of the following

Member is currently receiving necessary nursing facility services or meets minimum criteria to receive nursing facility services
Member is willing and able to reside safely in assisted living or community setting with support (for diversion/transition)
Specific timing/length criteria (if applicable)
- Member has been in a nursing facility for 60+ days (for transition eligibility)>= 60 days

Operational Guidance and Required Actions

Documentation Required

Use eligibility criteria for referrals

Providers should use the listed service-specific eligibility criteria when determining whether to refer a Medi‑Cal member to a Community Support service and must document which eligibility criteria the member meets.

Document which specific service eligibility criteria are met for each referral.

Prior Authorization

Refer to approved CS providers

Refer members only to Community Supports providers listed on findhelp with a claimed program card (checkmark) or via the Health Net provider directory; contact Health Net or Medi‑Cal Health Care Options for assistance.

Use findhelp at communitysupportsecm.findhelp.com and confirm the provider’s program card has been claimed (checkmark).
Alternatively, refer through the Health Net provider directory at the link provided.
For assistance, contact Health Net at 800-675-6110 or Medi‑Cal Health Care Options at 800-430-4263 (TTY: 800-430-7077).

Documentation Required

Housing deposit operational constraint

Housing deposits are available only when all county resources have been expended and the member is participating in housing navigation or tenancy programs; providers must document attempts to access county resources.

Confirm member is in housing navigation or housing tenancy services and that a need exists.
Document efforts and outcomes of attempts to access county resources prior to requesting a housing deposit.

Clinical and Program Background

Community Supports are part of California's CalAIM initiative through the Department of Health Care Services to address social determinants of health by funding non-clinical supports that help members remain stable in the community and avoid institutional care. Examples of these supports include assistance with housing (navigation, tenancy services, and deposits), provision of meals and medically tailored meals, respite and recuperative (medical respite/short-term post-hospitalization) services, and environmental adaptations such as ramps and grab bars to improve safety. The purpose of these services is to improve health outcomes and reduce institutional utilization by addressing upstream needs that affect a member’s ability to stay healthy in the community.

Defined Terms

HUD definition of homelessReference to the U.S. Department of Housing and Urban Development's definition of homelessness used to determine eligibility for certain services.

Use in eligibility determinationsMeets the Dept. of Housing and Urban Development (HUD) definition of homeless is an eligibility pathway for Housing Transition Navigation Services, Housing Tenancy and Sustaining Services, and Recuperative Care/Short-Term Post-Hospitalization Housing.

Referenced across servicesAppears as an eligibility criterion in multiple Community Supports entries (Housing Deposit, Housing Tenancy and Sustaining, Recuperative Care/Short-Term Post-Hospitalization Housing, and Asthma Remediation contexts).

Operational Notes

This quick reference is intended for referral and eligibility determination only. It does not include CPT/HCPCS/ICD codes, reimbursement rules, or detailed authorization procedures; providers should consult Health Net and state resources for operational billing and authorization requirements. For assistance contact Health Net at 800-675-6110 or Medi‑Cal Health Care Options at 800-430-4263 (TTY: 800-430-7077).

Asthma Control Test<= 19 (indicates poorly controlled asthma in past 12 months)

Nursing facility length for transition eligibility>= 60 days

Policy Summary

PayerHealth Net

PolicyCommunity Supports (CalAIM) — referral and eligibility quick reference

Policy CodePolicy N/A

Change TypeInformational

Effective DateN/A

Next Review DateN/A

Key ActionUse the service-specific eligibility criteria when referring Medi‑Cal members to Community Supports and document which criteria the member meets.

SourceLink

On This Page

OpenPayer

Community Supports (CalAIM) — referral and eligibility quick reference

Community Supports — Eligibility Criteria (CalAIM)

Procedure and Diagnosis Codes

Operational Guidance and Required Actions

Clinical and Program Background

Defined Terms

Operational Notes