CurrentmhnPolicy N/A

Community Supports (CalAIM) referral and eligibility quick reference

Guidance for referring Medi-Cal members to 14 Community Supports services under California's CalAIM program, summarizing service types and eligibility considerations for providers and referral staff in CalViva Health service area.

Policy Summary

Payermhn

PolicyCommunity Supports (CalAIM) referral and eligibility quick reference

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionUse the listed eligibility criteria (for example HUD homelessness definition, recent hospitalization, or functional deficits) to determine when to refer members to Community Supports services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

14Community Supports services listed

3CalViva counties covered

888-893-1569CalViva Health contact

800-430-4263State Medi-Cal contact (TTY)

Coverage criteria and service eligibility

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Service-specific eligibility criteria

Services are available when the service-specific eligibility criteria are met:

Housing Transition/Deposit: Member receives housing resources through the local homeless Coordinated Entry System or similar system; OR meets the Dept. of Housing and Urban Development (HUD) definition of homeless; OR is at-risk of experiencing homelessness

Housing deposits available when county resources expended and need identified

Recuperative Care / Short-Term Post Hospitalization Housing: Member is exiting recuperative care or is post-hospitalization or at-risk of hospitalization; AND meets the HUD definition of homeless

Short-term residential support after hospitalization

Sobering Centers: Member is age >=18 AND intoxicated and transported/present to the emergency department or a jail

Alternative destination for individuals who are intoxicated

Asthma Remediation: Member has poorly controlled asthma in the past 12 months as evidenced by an emergency department visit, hospitalization, two sick/urgent care visits, or an asthma control test score of 19 or lower

Physical home modifications to mitigate environmental asthma triggers

Meals/Medically Tailored Meals: Member has chronic conditions AND is discharged from the hospital or skilled nursing facility, or is at high risk of hospitalization, nursing facility placement, or requires extensive care coordination

Meals delivered to meet dietary needs including post-discharge

Nursing Facility Transition/Diversion: Member has been in a nursing facility for 60 or more days (for transition to assisted living) OR is currently receiving necessary nursing facility services or meets the minimum criteria to receive nursing facility services (for transition/home); AND is willing and able to reside safely in assisted living or community setting with support

Services to assist transition from institutional to community settings

Personal Care and Homemaker Services: Member is at-risk for hospitalization or institutionalization in a nursing facility OR has functional deficits and no other support system

Assistance with activities of daily living and homemaker tasks

Housing deposits are intended to support tenancy when a member is engaged in housing navigation or tenancy services and a need for a deposit has been identified. Per the policy, housing deposits are available only after all county resources have been expended, so referral and authorization should follow local resource exhaustion first. Ensure documentation clearly shows county resources were pursued and found insufficient before requesting housing deposit support.

Provider actions, referral & authorization notes

Note

Refer Members to Community Supports Services With this Quick Reference

Quick reference: Community Supports services and eligibility — use these criteria to determine when referrals are appropriate. Community Supports (CS) services are part of CalAIM to help improve the health of Medi-Cal members. Providers should use the listed eligibility criteria (for example: HUD definition of homeless, recent hospitalization/post-hospitalization status, receipt of local coordinated entry resources, at-risk of homelessness, or other service-specific criteria) to determine whether to refer a member for a given CS service.

Use eligibility criteria (HUD homeless definition, recent hospitalization/post-hospitalization, enrollment in Coordinated Entry System, at-risk of homelessness, etc.) to determine referrals for Community Supports services.
Housing Deposit sequencing: Housing deposits (Housing Deposit 1) are available only for members enrolled in housing navigation or housing tenancy services when a deposit is needed and all county resources have been exhausted.
Referral source restriction: Only refer to providers listed on findhelp if the provider's program card has been claimed (checkmark in the card's upper-right). If the findhelp program card is not claimed, refer using the health plan/provider directory or other approved referral channels.

Prior Authorization

Provider action highlights

Operational notes for providers:

Before making a referral, verify eligibility using the service-specific criteria (examples include HUD homeless definition, exiting recuperative care or post-hospitalization status, recent hospital discharge, or evidence of being at-risk of homelessness or institutionalization).
For Housing Deposit requests: confirm the member is enrolled in housing navigation or housing tenancy services, document that the deposit is required for securing housing, and confirm that all available county or local resources have been exhausted.
When using findhelp: only send referrals to programs whose program card shows a claimed status (checkmark). If a program card is not claimed, use the contracted provider directory or other approved referral pathways to ensure the provider can receive and act on the referral.

Service definitions and short descriptions

inv-09: Housing Transition Navigation Services — Assistance obtaining housing, applications, and housing support plan

DefinitionAssistance with obtaining housing including searching for housing, completing housing applications, and developing an individual housing support plan.

Included activitiesSearching for housing and completing housing applications.

Support planningDeveloping an individual housing support plan to address member-specific needs for obtaining stable housing.

Related servicesHousing Tenancy and Sustaining Services to help maintain tenancy once housing is secured (e.g., financial literacy, interventions for behaviors that jeopardize housing).

Eligibility noteHousing Deposit eligibility requires receiving housing resources through local Coordinated Entry or similar, meeting HUD definition of homeless, or being at-risk of homelessness.

inv-10: Recuperative Care (Medical Respite) — Short-term residential care for recovery post-hospitalization

DefinitionShort-term residential care for beneficiaries who no longer require hospitalization but still need to recover from injury or illness.

Care settingShort-term post-hospitalization housing where beneficiaries can continue receiving care for medical, psychiatric, or substance use disorder needs immediately following hospital discharge.

Typical beneficiariesIndividuals exiting recuperative care, post-hospitalization, or at-risk of hospitalization who meet HUD homelessness criteria.

Related supportsRespite services provide short-term relief for caregivers; sobering centers offer alternatives for intoxicated adults who would otherwise go to ED or jail.

inv-11: Asthma Remediation — Home modifications to mitigate environmental asthma triggers for poorly controlled asthma

DefinitionPhysical modifications to a beneficiary's home to mitigate environmental asthma triggers.

Eligibility (poorly controlled asthma)Member has poorly controlled asthma in the past 12 months defined by: an emergency department visit, hospitalization, two sick/urgent care visits, or an asthma control test score of 19 or lower.

PurposeHome-based environmental remediation to reduce exposures that exacerbate asthma and improve long-term control.

Timeframe for control assessmentPoor control must be demonstrated within the past 12 months.