CurrentmhnPolicy N/A

Housing Transition Navigation Services — Coverage Criteria

Defines eligibility, required documentation, provider requirements, covered activities, authorization periods, and billing codes for Housing Transition Navigation Services for Medi‑Cal members in the payer's jurisdiction.

Policy Summary

Payermhn

PolicyHousing Transition Navigation Services — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit the Community Supports (CS) Housing Navigation and Tenancy Referral Form for initial authorization and for extensions include the member's updated individualized housing support plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthsinitial authorization period

up to 18 monthspossible total authorization

H0043 U6supported housing code

Per diemunit of service

Coverage Criteria — Housing Transition Navigation Services

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Eligibility criteria

Covered when ALL of the following are met

Primary eligibility

Pathways: (1) Prioritized for permanent supportive housing or rental subsidy through the local Coordinated Entry System or similar system identifying highly vulnerable individuals with disabilities and/or one or more serious chronic conditions and/or serious mental illness, institutionalization or requiring residential services because of a substance use disorder and/or is exiting incarceration; OR (2) Meets the HUD definition of homeless per 24 CFR 91.5 (including those exiting institutions) and is receiving Enhanced Care Management, or has one or more serious chronic conditions and/or serious mental illness and/or is at risk of institutionalization or requiring residential services because of a substance use disorder; OR (3) Meets the HUD definition of at-risk of homelessness per 24 CFR 91.5.
Referenced statutory definitions and examples provided in policy.

At-risk subcriteria: Individuals determined at risk of experiencing homelessness are eligible if they have significant barriers to housing stability and meet at least one of the following: have one or more serious chronic conditions; have a serious mental illness; are at risk of institutionalization or overdose or require residential services because of a substance use disorder (or have serious emotional disturbance for children/adolescents); are receiving Enhanced Care Management; OR are transition-age youth with significant barriers to housing stability (examples: convictions, history of foster care, juvenile/ criminal justice involvement, serious mental illness, trafficking or domestic violence).

Transition-age youth examples are provided in source.

Scope of services

Covered activities (services included)

Service components: Tenant screening and housing assessment; development of an individualized housing support plan with short- and long-term measurable goals; housing search and presentation of options; assistance securing housing and required documentation (e.g., Social Security card, birth certificate, prior rental history); benefits advocacy including assistance with SSI documentation and application; identifying and securing rental subsidy and other resources; identifying and securing resources to cover expenses; assistance with requests for reasonable accommodation; landlord engagement and advocacy; ensuring living environment is safe and move-in ready; move assistance and move-in supports; developing housing retention and crisis plans with prevention and early intervention; coordinating non-emergency nonmedical transportation for housing access and move-in; and identifying/coordinating environmental accessibility modifications.

One-time expenses such as deposits and move-in costs are a separate in-lieu service under Housing Deposits.

The policy clarifies that the actual payment of housing deposits and move-in expenses is not part of Housing Transition Navigation Services. These one-time expenses are provided through a separate in-lieu service titled Housing Deposits (one-time expenses), and therefore should not be billed or authorized under the Housing Transition Navigation Services benefit.

Level of Care — Community-Based Housing Navigation

Community-based Housing Navigation / Outpatient-like community support

Used to determine level of care for Community-based Housing Navigation / Outpatient-like community support

Admission examples: Individuals prioritized for permanent supportive housing or rental subsidy, those who meet the HUD definition of homeless (24 CFR 91.5) including those exiting institutions, or those who meet HUD at-risk of homelessness criteria and have significant barriers to housing stability (see children/youth and transition-age youth exceptions).

Referenced throughout eligibility section.

Continued authorization: Extensions are reviewed in 6-month increments based on need; total authorization may reach up to 18 months (initial 12 months plus a 6-month extension). Provider must supply an updated individualized housing support plan for extension review.

See authorization requirements and documentation.

Provider Actions — Authorization, Documentation, and Restrictions

Prior Authorization

Prior Authorization Required

Initial authorization is for a period of 12 months. Extensions are granted in 6-month increments and may allow services up to a total of 18 months (initial 12 months plus up to one 6-month extension). Extensions are reviewed and approved based on documented ongoing need.

Initial authorization: 12 months
Authorization extensions: reviewed and approved in 6-month increments, total up to 18 months

Note

Service Concurrency Restriction

With the exception of the first month after the member becomes housed, a member should not receive Housing Tenancy and Sustaining Services and Housing Transition Navigation Services concurrently in the same month. The first month housed is allowed as an exception to permit transition supports.

Exception: first month housed may receive both services
Otherwise: do not bill Housing Tenancy and Sustaining Services and Housing Transition Navigation Services in the same month

Documentation Required

Documentation and Denial Risks

Documented evidence is required for initial authorizations and extensions. For initial authorization, submit the Community Supports (CS) Housing Navigation and Tenancy Referral Form. For authorization extensions, submit the CS Housing Navigation and Tenancy Referral Form plus the member's updated individualized housing support plan demonstrating continued need. Services must be identified as reasonable and necessary in the individual's housing support plan, and community supports must supplement — not supplant — other state, local, or federally funded benefits.

Initial authorization documentation: Community Supports (CS) Housing Navigation and Tenancy Referral Form
Extension documentation: CS Housing Navigation and Tenancy Referral Form and updated individualized housing support plan
Services must be documented as reasonable and necessary in the individualized housing support plan
Community supports shall supplement and not supplant other funded programs

Key Definitions — Homelessness and At-Risk Status

Homeless / At-risk definitions — HUD criteria (24 CFR §91.5)

Authoritative sourceHUD definitions per Section 91.5 of Title 24 of the CFR

At-risk income and resourcesAnnual income below 30% of area median AND lacks sufficient resources/support networks to avoid homelessness (e.g., no family/friends/faith-based support)

Imminent loss of housingNotified in writing that right to occupy current housing will be terminated within 21 days of application for assistance

Unstable housing situationsLiving in hotel/motel (not paid by charity/government), overcrowded SRO/units, or housing with characteristics identified as having increased risk of homelessness

Exiting institutions or systems of careIncludes exiting publicly funded institutions or systems such as health-care facilities, mental health facilities, foster care, correctional programs, or other youth facilities

Transition-age youth examplesTransition-age youth with significant barriers include those with convictions, foster care history, juvenile/ criminal justice involvement, serious mental illness, serious emotional disturbance, or victims of trafficking/domestic violence

Background — Purpose and Program Summary

Housing Transition Navigation Services are intended to assist members with obtaining and retaining housing by assessing barriers, developing individualized housing support plans, and connecting members to needed resources. Covered activities include tenant screening and housing assessment; development of an individualized housing support plan; housing search and presentation of options; assistance securing necessary documentation and applications; benefits advocacy (including support for SSI applications); identifying and securing rental subsidies and other resources; assistance with reasonable accommodations; landlord engagement; move-in readiness and move assistance; developing housing retention and crisis plans; coordinating non-emergency nonmedical transportation; and coordinating environmental accessibility modifications. The service is targeted to individuals prioritized for permanent supportive housing or rental subsidy, those meeting HUD definitions of homeless or at-risk of homelessness, or those with significant barriers to housing stability such as serious chronic conditions or serious mental illness.