CalAIM

Benefit Changes under Medi-Cal

Enhanced Care Management & Community Supports

We would like to tell you about some new services available through your CenCal Health insurance starting on July 1, 2022.

California seeks to improve the Medi-Cal program for people with complex needs and who are facing difficult life and health circumstances. These new services are focused on providing assistance beyond traditional medical services. They are designed to address social drivers of health (factors in people’s lives that influence their health). Enhanced Care Management and Community Supports are the names of two new, statewide Medi-Cal services.

The section below is what will be changed in the Member Handbook/ Evidence of Coverage (EOC) soon. Please keep this page for your records until the Member Handbook (EOC) is updated and shared with you.

Enhanced Care Management

Enhanced Care Management (ECM) is a new benefit for CenCal Health Members with complex needs.

ECM provides extra services to help you get the care you need to stay healthy and at no cost to you. It coordinates the care you get from different doctors.

ECM helps coordinate:

• Primary care
• Acute care
• Behavioral health
• Developmental Health
• Oral health
• Community-based long-term services and supports (LTSS)
• Referrals to available community resources

ECM Lead Care Manager

If you qualify for ECM, you will be contacted by an ECM provider.

This provider may be your PCP office or a government or community agency. The ECM provider will help you enroll in the ECM program and assign you a lead care manager.

This person will coordinate care between:

• You
• our doctors
• Specialists
• Pharmacists
• Case managers
• Social services providers
• Others

They will make sure everyone works together to get you the care you need. The lead care manager can also help you find and apply for other services in your community.

You can also call CenCal Health Member Services at 1-877-814-1861 (TTY/TDD 1-833- 556-2560 or 711) to find out if and when you can receive ECM. Or you can talk to your health care provider.

ECM services include:

• Outreach and engagement
• Comprehensive assessment and care management
• Enhanced coordination of care
• Health promotion
• Comprehensive transitional care
• Member and family support services
• Coordination and referral to community and social supports (link to ECM Referral Form- in production)
• ECM Program Flyer – English / ECM Program Flyer – Spanish

Community Supports 

View the 2024 Community Supports ERRATA in English and Spanish regarding updates to the benefits/information. 

What are Community Supports? 

Community Supports are optional services for Medi-Cal members that may not include direct medical care. CenCal Health offers Community Supports free of charge, to help members with complex health issues. These health issues are often caused or made worse by lack of food, housing, or transportation. 

Community Supports include: 

• Medically Tailored Meals/Medically Supportive Food
• Recuperative Care
• Sobering Center Services
• Housing Transition and Navigation Services
• Housing Tenancy and Sustaining Services
• Housing Deposit Services
• Day Habilitation
• Short Term Post Hospitalization
• Respite Services
• Personal Care & Homemaker
• Asthma Remediation  
• Community Transition Services/Nursing Facility Transition to a Home –  
• Environmental Accessibility Adaptations  
• Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for Elderly (RCFE) and Adult Residential Facilities (ARF) Services –  

How do I get Community Supports? 

You can be referred to Community Supports by: 

• Your ECM provider
• Primary doctor
• Social services providers
• Other providers
• Yourself or your family 

When can I get Community Supports? 

Community Supports will be available to eligible members starting July 1, 2022. 

Who do I call if I have questions about Community Supports? 

You can call CenCal Health Member Services at 1-877-814-1861 Monday to Friday, 8a.m. to 5p.m. (TTY/TDD 1-833- 556-2560 or 711). 

Community Supports overview:
Community Supports Overview PDF  – English
Community Supports Overview PDF – Spanish 

Asthma Remediation

In this program, CenCal Health helps members keep their independence at home by providing practicalupgrades that will decrease asthma triggers. The services in this program may include:

• Small home repairs (ex. pest management, patching holes, minor mold removal, ventilation
  improvements, etc.)
• Access to allergen proof bedding
• Use of high-efficiency particulate air (HEPA) filters and vacuums
• Access to asthma-friendly cleaning products
• De-humidifiers
• Cost effective interventions as needed

Community or Home Transition Services

In this program, CenCal Health helps members transition back home from a nursing home or Medical Respite. This service helps members who have been in for more than 60 days and want to live safely at home with the right help.

The services in this program may include:

• Searching for housing and giving options
• Help filling out forms
• Moving to a private home from a medical facility
• Creating and using a housing plan
• Getting funds for home security deposits or fixes to make it easier to live in the home (like adding
  grab bars)
• Finding transportation

Day Habilitation

In this program, CenCal Health will help members who are currently or were previously experiencing homelessness with training and support to develop or improve the skills needed to live successfully in their environment.

The services in this program include:

• Using public transit
• Learning conflict resolution skills
• Participating in the community
• Building social relationships
• Practicing daily living skills (cooking, cleaning, money management)
• Learning about community resources, such as police, fire, or local services

Discontinuation of Assisted Living Facility Transitions (ALFT)

CenCal Health will discontinue the Assisted Living Facility (ALFT) Community Support effect December 31, 2025.
This decision was made after reviewing program utilization and local feasibility. While ALFT will no longer be offered, members continue to have access to other supports that promote safe and independent living, including:

• Personal Care and Homemaker Services
• Respite Services
• Long-Term Care
• In-Home Supportive Services (IHSS)
• Enhanced Care Management (ECM)
• Community Based Adult Services (CBAS)
• Home and Community Based Alternatives (HCBAS) Waiver program

Current ALFT members will continue to receive services through the end of their authorized period. CenCal Health will work closely with providers and members to ensure a smooth transition to other available supports. For questions, please contact CenCal Health Provider Relations at psrgroup@cencalhealth.org or call (805) 562-1676.

Environmental Accessibility Adaptations (EAA) Home Modifications

In this program, CenCal Health will help members who would otherwise need to move to a nursing facility, keep their independent housing by providing practical upgrades to their home that will make it easier to live in.

The services in this program may include:

• Installing ramps and grab-bars.
• Access to Personal Emergency Response System (PERS) – a button to call for help in an
  emergency.
• Wheelchair accessible bathrooms, showers, and doorways.
• Stair lifts.
• Installing specialized electric and plumbing systems to aid with medical equipment and supplies.

Housing Deposits

In this program, CenCal Health helps members who are experiencing homelessness or at risk of homelessness find or pay for one-time services needed to establish a basic household.

The services in this program include:

• Security deposits to lease an apartment or home
• Utility set-up fees and arrears
• First month coverage of utilities (gas, telephone, electricity, heating, water, etc.)
• Services needed to make the space safe, if necessary (like pest control, minor repairs to meet HUD
• Housing Choice Voucher program quality standards, and one-time cleaning)
• Application fees to cover cost of the lease application
• Items like air conditioner and heater, and other medically necessary supplies (hospital beds, Hoyer lifts, air filters, or others including essential household furnishings)

Housing Tenancy and Sustaining Services (HTSS)

In this program, CenCal Health helps members at risk of losing their housing, keep housing, and make
sure it is safe.

The services in this program include:

• Offering education on rights and responsibilities as a tenant
• Coaching on how to be a successful tenant
• Coaching on independent living/life skills
• Working with the landlord on any issues
• Help with resolving disputes with landlord or neighbors to avoid eviction
• Referral to community resources to prevent eviction
• Help getting a reasonable accommodation, if necessary
• Helping with applications for other benefits
• Helping with annual housing recertification process
• Creating a personal housing support and crisis plan

Housing Transition Navigation Services (HTNS)

In this program, CenCal Health helps members experiencing homelessness or at risk of homelessness
find a place to live.

The services in this program include:

• Discussing living preferences and anything that is stopping one from having stable housing
• Creating a personal housing support and crisis plan
• Searching for housing and giving options
• Helping with housing applications
• Helping to sign up for other benefits
• Finding resources to cover things like security deposit, moving costs, and other expenses
• Help getting a reasonable accommodation, if necessary
• Working with landlords
• Making sure the living space is safe
• Setting up transportation services if necessary

Medically Tailored Meals Program (MTM)/Medically Supportive Food (MSP)

In this program, CenCal Health helps members with chronic or other serious nutrition-sensitive conditions to improve their health with the right foods.

Personal Care and Homemaker Services (PCHS)

In this program, CenCal Health helps members who need help with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These services are similar to In-Home Supportive Services and help members to remain in their homes.

The services in this program may include help with:

• Bathing, dressing, or feeding
• Bowel and bladder care
• Meal preparation
• Grocery shopping
• Money management
• Assist with attending doctor appointments
• Laundry

Recuperative Care Program (RCP)

In this program, CenCal Health helps members who are experiencing or at risk of homelessness and
need a short-term residential setting to recover from an injury or illness.

The services in this program may include:

• Temporary housing with a bed and meals.
• Limited or short-term help with grooming, dressing, showering, meal preparation with taking medication and/or helping you get out of bed.
• Coordination of transportation to post-discharge appointments.
• Connection to any other on-going services and individual may require, including mental health and substance use disorder services.
• Support in accessing benefits and housing.

Respite Services

In this program, CenCal Health gives a member’s caregiver short-term relief. It is for members who live
in the community, need help with daily activities, and depend on a caregiver for most of their support to
avoid moving into a care facility. Children who previously received respite services under the pediatric
palliative care waiver, foster care program beneficiaries, members in California Children’s Services or
the Genetically Handicapped Persons Program, and members with complex care needs also qualify.
Care can be provided in the member’s home or in an approved out-of-home location.

The services in this program may include:

• Light cleaning
• Cooking
• Laundry services
• Rest for caregiver(s)

Short-Term Post Hospitalization Housing

In this program, CenCal Health helps members who are experiencing or at risk of homelessness, have an ongoing physical or behavioral health need as determined by qualified health professional, and are exiting from recuperative care, inpatient hospitals (acute or psychiatric or chemical dependency and recovery hospital), residential substance use disorder or mental health treatment facility, correctional facilities, or nursing facilities, and who need a safe and supportive place to recover.

The services in this program include:

• Temporary housing
• Referrals to Housing Transition Navigation Services
• Ongoing support needed for healing and recovery
• Help with getting medical and/or behavioral health care

Sobering Centers

In this program, CenCal Health helps members who are 18 or older, experiencing homelessness, or do
not have a stable housing, and who are publicly intoxicated from alcohol and/or other drugs find a safe
place to get sober instead of going to the Emergency Room or jail.

The services in this program include:

• Medical triage
• Lab testing
• A temporary bed
• Rehydration and food services
• Treatment for nausea
• Wound and dressing changes
• Shower and laundry facilities
• Substance use education and counseling
• Help connecting to other substance use services
• Other needed health care services

Transitional Rent (Go Live 1/1/26)

CenCal Health offers Transitional Rent in limited circumstances and is designed to support housing
stability for eligible members. In this program, CenCal Health will connect individuals with certain health
conditions, who are experiencing, or at risk of homelessness, to a Transitional Rent Provider, to help
coordinate up to six months of rental assistance for permanent or temporary housing (subject to the sixmonth global cap on Room and Board services within a rolling 12-month period).

The services in this program include:

• Rental assistance in allowable settings
• Storage fees, amenity fees, and landlord-paid utilities that are charged as part of the rent payment