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 – Starting on 07/1/2024
• Community Transition Services/Nursing Facility Transition to a Home – Starting on 07/1/2024
• Environmental Accessibility Adaptations -Starting on 07/1/2024
• Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for Elderly (RCFE) and Adult Residential Facilities (ARF) Services – Starting on 07/1/2024

Asthma Remediation – Starting 7/1/2024

Asthma remediation services are changes made to a home to keep someone with asthma healthier and safe. Services also help them live in their home more easily. Without these services, asthma attacks are more likely, and may lead to trips to the hospital.

Asthma Remediation services provide:

• Special covers for mattresses and pillows that keep allergens out
• Vacuums with special filters that trap tiny particles
• Services to get rid of pests, like bugs, in a safe way
• Machines that take moisture out of the air
• Cleaning up small amounts of mold

Community Tranistion Services/Nursing Facility Transition to a Home – Starting 7/1/2024

This program 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.

Community Transition Services help with:

• Moving to a private home from a medical facility
• Creating and using a housing plan
• Getting funds for home fixes to make it safer (like adding grab bars)
• Finding transportation

Day Habilitation

This program assists Members currently or previously experiencing homelessness with training and help to develop or improve skills they need to live successfully in their environment.

Day Habilitation trainings include but are not limited to:

• How to use public transportation
• Conflict Resolution skills
• Cooking
• Cleaning
• Shopping

Enviromental Accessibility Adaptations (Home Modifications) – Starting 7/1/2024

In this program, Members receive help with home changes to stay healthy, safe, and independent at home. These changes help people stay out of places like nursing homes.

Home modification(s) are services such as:

• Building a ramp(s) and installing grab-bars to help Members get into their home
• Making doorways wider for Members who use a wheelchair
• Installing a lift for stairs
• Changing bathroom(s) and shower(s) to be wheelchair accessible, like having a roll-in shower
• Putting in special electric and plumbing systems for medical equipment
• Setting up a Personal Emergency Response System (PERS) for Members who are often alone and may need help quickly

Housing Deposits

CenCal Health will help members experiencing homelessness or at risk of homelessness find or pay for one-time services needed for your living space. This includes things like:

• Security deposits to lease an apartment or home
• Utility set-up fees and first month bills (gas, telephone, electricity, heating, water, etc.)
• First and last month’s rent, if required by landlord
• Services needed to make the space safe, if necessary (like pest control, and one-time cleaning)
• Items like A/C and Heater, and other medically necessary supplies (hospital beds, Hoyer lifts, air filters, or others)

Housing Tenancy and Sustaining Services

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

• Helping solve issues like late rent, hoarding, substance use, and other lease violations
• Offering education on member rights and responsibilities as a tenant
• Coaching on how members can 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
• Helping with applications for other benefits
• Helping with annual housing recertification process
• Creating a personal housing support and crisis plan
• Providing health and safety visits

Housing Transition Navigation Services

This program helps Members experiencing homelessness or at risk of homelessness obtain housing. Housing Transition Navigation Services include:

• Discussing your living preferences and anything that is stopping you from having stable housing
• Creating a personal support plan
• Searching for housing options and giving you choices
• Helping you with housing applications
• And more

Medically Tailored Meals Program/Medically Supportive Food

This service is available to members with chronic conditions and chronic or disabling mental/behavioral health disorders; members discharged from the hospital or skilled nursing facility or at a high-risk hospitalization or nursing facility placement; or members with extensive care coordination needs. The Medically Tailored Meals program provides members access to medically appropriate meals designed by registered dietitians. Members who qualify will be provided with two meals delivered to their homes for up to 12 weeks.

The Medically Tailored Meals Program provides meals to members who meet one of the following eligibility criteria:

• Has a chronic condition(s)
• Discharged from an inpatient hospital visit or emergency room visits
• Discharge from a Skilled Nursing Facility
• Has complex care coordination needs

Meals provided to each member are based on their medical needs and utilization of emergency rooms, hospitals, and skilled nursing facilities.

Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residental Care Facilities Care for Elderly (RCFE) and Adult Residential Facilities (ARF) Services – Starting 7/1/2024

This program helps with transitions out of a nursing facility. You will get help moving back into a home-like, community setting. This program also helps prevent nursing facility stays for those with imminent need. Services include:

• Help finding a place to live
• Filling out forms
• Getting important documents ready (Social Security card, birth certificate, and rental history)
• Help coordinating a move to a residential facility
• Improving the help you receive to make sure you have a safe and stable place to live after the transition

Personal Care and Homemaker Services

This program is for members who need help with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). This program includes In-Home Supportive Services and helps members to remain in their homes.

Personal Care and Homemaker Services provides help with:

• Eating and drinking
• Using the bathroom
• Meal preparation
• Bowel and bladder care
• Bathing
• Grocery Shopping
• Accompaniment to medical and mental health appointments

Recuperative Care Program (RCP)

This is a service available for members experiencing homelessness who need medical services and resources after hospital discharge. The intent of the RCP is to improve health outcomes and decrease use of emergency room and hospital facilities. The RCP is available for those who meet criteria for up to 90 days after a hospital stay.

Some RCP services offered to members are:

• Temporary housing
• Medical care
• Case management
• Self-management support

Respite Services

These services are provided to members’ caregivers. The services are provided on a short-term basis if the caregiver must be absent or needs relief.

Respite Services provides:

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

Short-term Post Hospitalization Housing

This program is for Members who do not have a residence and who have high medical or behavioral health needs. This program allows for members to continue their recovery immediately after exiting one of the following facilities:

• Inpatient hospital
  • Acute care hospital
  • Psychiatric hospital
  • Chemical Dependency and Recovery hospital
• Residential substance use disorder treatment or recovery facility
• Residential mental health treatment facility
• Correctional facility
• Nursing facility
• Recuperative care

Short-term Post Hospitalization Housing provides:

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

Sobering Centers

CenCal Health helps members aged 18 years and older who are publicly intoxicated (due to alcohol and/or other drugs). Instead of going to the Emergency Room or jail, members can go to a different safe place to get sober. This program is mostly for Members who are homeless or who do not have a stable living situation.

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