DraftmhnPolicy N/A

Transitional Rent (Community Supports) — Coverage Criteria

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Defines eligibility, provider and plan responsibilities, settings, documentation, authorization processes, and limits for Transitional Rent rental assistance as a Medi‑Cal Community Supports service affecting members and contracted providers in the plan network.

Policy Summary

Payermhn

PolicyTransitional Rent (Community Supports) — Coverage Criteria

Policy CodePolicy N/A

Change TypeMaterial — new Community Supports requirementglobal cap guidance

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit authorization with required documentation (lease, housing inspection, referral, Housing Support Plan) within 6 months of the Behavioral Health Point of Focus (BH POF).

SourceLink

POLICY UPDATE CHANGES

Effective January 1, 2026, Transitional Rent will be mandatory for Plans as the fifteenth Community Supports service and implemented in phases for select populations.

A global cap limits combined Short-Term Post-Hospitalization Housing, Recuperative Care and Transitional Rent to six months within a rolling 12-month period for a member.

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DraftmhnPolicy N/A

Transitional Rent (Community Supports) — Coverage Criteria

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Policy Summary

Payermhn

PolicyTransitional Rent (Community Supports) — Coverage Criteria

Policy CodePolicy N/A

Change TypeMaterial — new Community Supports requirementglobal cap guidance

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit authorization with required documentation (lease, housing inspection, referral, Housing Support Plan) within 6 months of the Behavioral Health Point of Focus (BH POF).

SourceLink

POLICY UPDATE CHANGES

Effective January 1, 2026, Transitional Rent will be mandatory for Plans as the fifteenth Community Supports service and implemented in phases for select populations.

A global cap limits combined Short-Term Post-Hospitalization Housing, Recuperative Care and Transitional Rent to six months within a rolling 12-month period for a member.

up to 6 monthsTransitional Rent duration

6 monthsGlobal cap (combined services)

5 daysMCP auth/deny timeframe

14 daysBHSA referral to MCP timeframe

5Required Housing Support Plan elements

Coverage and Eligibility Criteria

inv-01: BH POF Eligibility

Covered when ALL of the following are met:

BH POF Transitional Rent Eligibility: 1) Authorization is requested within 6 months of the Behavioral Health Point of Focus (BH POF); 2) Clinical Risk Factor: member meets access criteria for Specialty Mental Health Services (SMHS) or Drug Medi-Cal (DMC), including DMC-ODS where specified; 3) Social Risk Factor: member is experiencing or at risk of homelessness; AND 4) Specified Transitioning Criteria: member is transitioning from an institutional or congregate residential setting, a carceral setting, an interim setting, recuperative care or short-term post-hospitalization housing, foster care, or is experiencing unsheltered homelessness.

Exact combinations and timing requirements are specified in source policy; referrals to Transitional Rent Providers should occur when housing is secured.

inv-02: Duration and Global Cap

Covered when service limits do not exceed global caps:

Duration and Global Cap: Transitional Rent is provided for up to six months per member; a member may not receive more than a combined six months of Short-Term Post-Hospitalization Housing, Recuperative Care, and Transitional Rent within a rolling 12-month period.<= 6 months per rolling 12 months across Room & Board services

Managed Care Plans (MCPs) must calculate combined months across the three services prior to authorizing Transitional Rent; global cap guidance effective January 1, 2025.

Authorization requests that would result in a member receiving more than a combined six months of Room and Board services (Short-Term Post-Hospitalization Housing, Recuperative Care, and Transitional Rent) within a rolling 12‑month period must adhere to the DHCS global cap and may be denied. MCPs must evaluate combined months across these services before approving authorization to ensure the 6‑month combined limit is not exceeded.

No additional coverage criteria are specified in the source excerpts for this section.

Services that would cause a member to exceed the global Room and Board cap are not allowable under the covered benefit; specifically, a member may not receive more than a combined six months of Short‑Term Post‑Hospitalization Housing, Recuperative Care, and Transitional Rent within any rolling 12‑month period.

No additional coverage criteria are specified in the source excerpts for this section.

Level of Care / Service Definition

Housing Support Interventions

inv-21: Housing support interventions

Housing Support Plan Requirements: The Housing Support Plan must: 1) identify the permanent housing strategy and solution (including payment sources/mechanisms) to support housing after Room & Board services are exhausted; 2) identify permanent housing supports to sustain tenancy; 3) be informed by member preferences and revised as needed; 4) be based on a housing assessment that addresses barriers and includes short- and long-term measurable goals and approaches; and 5) be developed in a culturally appropriate and trauma-informed manner.

Providers must verify housing setting qualifications and habitability, create/update the Housing Support Plan, and include the Plan with authorization documentation to the MCP.

Provider and Plan Responsibilities

Prior Authorization

Authorization timing and BH POF eligibility

Authorization for Transitional Rent (TR) must be requested within 6 months of the member's Behavioral Health Point of Focus (BH POF) event. The member must meet BH POF eligibility (e.g., clinical access criteria for SMHS or DMC/DMC-ODS and social risk factors such as experiencing or at risk of homelessness, or specified transitioning criteria like leaving institutional, congregate, carceral, foster care, recuperative care, or interim settings).

Authorization timeframe: within 6 months of the BH POF event
BH POF eligibility examples: meet access criteria for SMHS or DMC/DMC-ODS AND social risk factor = experiencing or at risk of homelessness, or specified transitioning criteria (e.g., transitioning out of institutional, congregate residential, carceral, foster care, recuperative care, short-term post-hospitalization housing, interim settings)

Prior Authorization

Prior authorization — payer-specific PA requirements not specified

Prior authorization requirements are required for Transitional Rent; however, payer-specific submission channels or form details are not specified in this policy. Providers should submit required documentation to the member's Managed Care Plan (MCP) per plan instructions and confirm any plan-specific PA processes directly with the MCP.

Examples, Days Remaining, and Financials

inv-07: Days Remaining / Available Days

Days remaining (example)75 days

Example monthly rent amount$2,990.00

Transitional Rent total amount (example)$7,523.23

Definitions and Key Terms

inv-18: Transitional Rent

DefinitionTime-limited rental assistance provided in interim and permanent settings to Members experiencing or at risk of homelessness who meet clinical risk factors and specified transition criteria (up to six months).

Purpose summaryStabilize members to connect them to health care services and to long-term housing supports such as rental subsidies.

Implementation effective dateEffective January 1, 2026 — mandatory for Plans as the fifteenth Community Supports service.

Benefit durationUp to 6 months per member (subject to global cap across room & board services).

inv-19: Housing Support Plan

Permanent housing strategyMust identify the permanent housing strategy and solution, including payment sources and mechanisms to sustain housing after Room & Board services end.

Background and Scope

Transitional Rent is a time‑limited rental assistance benefit intended to stabilize members experiencing or at risk of homelessness, particularly those with behavioral health clinical risk factors or who are transitioning from institutional, carceral, foster care, interim, or post‑hospital settings. The program provides interim rental support while the member engages in a Housing Support Plan and transitions to long‑term housing solutions.

Policy Summary

Payermhn

PolicyTransitional Rent (Community Supports) — Coverage Criteria

Policy CodePolicy N/A

Change TypeMaterial — new Community Supports requirementglobal cap guidance

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit authorization with required documentation (lease, housing inspection, referral, Housing Support Plan) within 6 months of the Behavioral Health Point of Focus (BH POF).

SourceLink

On This Page

PA required but payer-specific submission details not specified — check MCP for exact process
Submit complete documentation (see documentation callouts) to avoid delays

Denial Risk

Global cap exceedance

Do not request authorization if approval would cause the member to exceed the global cap. The DHCS global cap limits combined Room and Board services (Transitional Rent, Recuperative Care, Short-Term Post-Hospitalization Housing) to a maximum of six months within a rolling 12-month period. Authorization requests that would result in exceeding this six-month combined limit are not allowable.

Global cap: combined 6 months of Room and Board services per rolling 12-month period (effective Jan 1, 2025 guidance)
Requests exceeding the member's remaining eligible days under the global cap will be denied or must be reduced

Documentation Required

Housing Support Plan completeness

Housing Support Plan submissions must be complete and include all required elements. Incomplete or missing Housing Support Plan information may result in denial or an incomplete authorization request. Ensure the plan clearly documents strategy, supports, payment sources, measurable goals, assessments, and culturally appropriate, trauma-informed approaches.

Housing Support Plan must identify permanent housing strategy and payment sources (e.g., BHSA voucher or other long-term rental subsidy)
Must identify permanent housing supports (e.g., tenancy-sustaining services, utilities)
Be informed by member preferences and updated as member circumstances change
Include a housing assessment with barriers, short- and long-term measurable goals, approach to meet goals, and when other providers/services are needed
Developed in a culturally appropriate and trauma-informed manner

Documentation Required

Required Documentation for Submission to MCP

Required documentation to submit to the Managed Care Plan includes: Lease agreement, Housing Inspection Form, Referral Form, and the Housing Support Plan. Provide clear, complete copies of each document to support timely review and authorization.

Lease agreement
Housing Inspection Form (completed)
Referral Form
Housing Support Plan (completed with required elements)

Documentation Required

Housing inspection and habitability requirements

Housing Inspection Form must document habitability elements (structure and materials, egress, space and security, acceptable sleeping place, interior air quality and ventilation, water supply, sanitary facilities, thermal environment/heating & cooling) and reference applicable habitability checklists (e.g., HPRP/HCD habitability standards).

Structure and materials: structurally sound and safe
Means of egress: alternate egress in case of fire
Space and security: adequate space and secure storage for belongings; acceptable sleeping place
Interior air quality: natural or mechanical ventilation; free of harmful pollutants
Water supply: free from contamination
Sanitary facilities: access to sufficient facilities for personal cleanliness and waste disposal
Thermal environment: adequate heating and/or cooling in working condition

Note

Provider and MCP authorization workflow

Provider and MCP authorization workflow: Transitional Rent providers must verify member eligibility, confirm housing setting qualifications and habitability, create or update the Housing Support Plan and Voucher Confirmation, pay rent to landlords, and submit the authorization request and claims for reimbursement to the Managed Care Plan. MCPs will review submitted documents, authorize eligible members for Transitional Rent and related housing trio services, calculate the global cap across the three Room and Board services before approving authorization, and process claim reimbursements.

Provider actions: review eligibility, verify housing setting, perform/submit housing inspection, prepare Housing Support Plan and voucher confirmation, submit authorization and claims, facilitate transition when benefit exhausts
MCP actions: review required documents, authorize eligible members for Transitional Rent and housing trio services, calculate and enforce global cap across Room and Board services, process reimbursements

Documentation Required

Required documentation for Housing Support Plan and transitional rent details

Transitional Rent calculations and key housing setting information should be included with authorization submissions to demonstrate days and amounts requested relative to member eligibility and remaining global cap allowance. Provide itemized monthly rent amounts, available days, total amount requested, and start/end dates as applicable.

Include Key Housing Setting Information (e.g., address, setting type, bedrooms, county, start date, rent amount, days eligible, days remaining)
Include Transitional Rent Calculations (per-month amounts, available days per month, total days and total amount requested)

Permanent supports to sustain tenancyList the full range of housing supports (e.g., tenancy-sustaining services, utilities) needed to maintain tenancy.

Member preferences and revisionsBe informed by Member preferences and needs and be reviewed and revised as circumstances change.

Housing assessment with measurable goalsBe based on a housing assessment that identifies barriers, includes short- and long-term measurable goals, and specifies approaches and when other providers/services are required.

Cultural and trauma-informed developmentDevelop the plan in a way that is culturally appropriate and trauma-informed.