Community Supports

In this program, CenCal Health helps members keep their independence at home by providing practical upgrades 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

Restrictions/Limitations

• If another State Plan service beyond the APS, such as Durable Medical Equipment (DME), is available and would accomplish the same goals of preventing asthma emergencies or hospitalizations, the State Plan service should be accessed first.
• Asthma remediations must be conducted in accordance with applicable State and local building codes.
• Asthma remediations are payable up to a total lifetime maximum of $7,500. The only exception to the $7,500 maximum is if the member’s condition has changed significantly and additional modifications are necessary to ensure the member’s health, welfare, and safety, or to increase their independence and avoid institutionalization or hospitalization.
• Asthma Remediation home modifications are limited to those that are of direct medical or remedial benefit to the member and exclude adaptations or improvements that are of general utility to the household. Remediations may include finishing (e.g., drywall and painting) to return the home to a habitable condition, but do not include aesthetic embellishments.
• Before commencement of any permanent physical adaptation to the home or installation of equipment—such as an exhaust fan or replacement of moldy drywall—CenCal Health must provide the owner and member with written documentation stating that the modifications are permanent and that the State is not responsible for maintenance, repair, or removal of the modification if the member moves out.
• This requirement does not apply to the provision of supplies that are not permanent adaptations or installations, including but not limited to: allergen-impermeable mattress and pillow covers, HEPA vacuums, de-humidifiers, portable air filters, and asthma-friendly cleaning products and supplies.

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 providing housing options
• Help filling out forms
• Moving to a private home from a medical facility
• Creating and using a housing plan
• Funding for home security deposits or home modifications (such as grab bars)
• Finding transportation

Restrictions/Limitations

• Community Transition Services do not include monthly rental or mortgage expenses, food, regular utility charges, or household appliances or items intended for purely diversionary or recreational purposes.
• Non-recurring set-up expenses are payable up to a total lifetime maximum of $7,500. The transitional coordination cost is excluded from this cap.
• The only exception to the $7,500 maximum is when a member is compelled to move from a provider-operated living arrangement to a private residence or public subsidized housing due to circumstances beyond their control.
• Community Transition Services must be necessary to ensure the member’s health, welfare, and safety. Without these services, the member would be unable to move to a private residence or public subsidized housing and would require continued or repeat institutionalization.
• A member may be eligible for waiver or demonstration programs (e.g., CCT, Home & Community Based Alternatives) as well as this Community Support; however, they cannot receive both simultaneously if services overlap or are duplicative.
• CenCal Health is encouraged to assist members with enrollment in appropriate and available waiver/demonstration programs when beneficial.

In this program, CenCal Health helps 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, and local services

Restrictions/Limitations

• Program services are available for as long as necessary. They may be provided continuously or through periodic meetings, either individually or in group settings.

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

The services in this program may include:

• Installing ramps and grab bars
• Access to a Personal Emergency Response System (PERS) — a button to call for help in an emergency
• Wheelchair-accessible bathrooms, showers, and widened doorways
• Stair lifts
• Installing specialized electrical or plumbing systems needed for medical equipment and supplies

Restrictions/Limitations

• If another State Plan service (such as Durable Medical Equipment) is available and would accomplish the same goals of promoting independence and preventing institutional placement, that service must be used first.
• Environmental Accessibility Adaptations (EAAs) must comply with all applicable State and local building codes.
• EAAs are payable up to a total lifetime maximum of $7,500. Exceptions to this limit may be made if:
  • The member’s residence changes, or
  • The member’s condition changes significantly and additional modifications are necessary to ensure their health, welfare, or safety, or to enable greater independence and avoid institutionalization or hospitalization.
• EAAs may include finishing work (e.g., drywall and painting) to return the home to a habitable condition but do not include aesthetic upgrades or embellishments.
• Modifications are limited to those that provide direct medical or remedial benefit to the member. Improvements that are of general utility to the household are not covered.
• Adaptations that add to the total square footage of the home are excluded, except when such expansion is necessary to complete the adaptation (for example, improving entrance/egress or configuring a bathroom to accommodate a wheelchair).

In this program, CenCal Health helps members who are experiencing homelessness or are 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, such as:
  • Pest control
  • Minor repairs to meet HUD Housing Choice Voucher quality standards
  • One-time cleaning services
• Application fees for lease applications
• Items such as air conditioners, heaters, and medically necessary supplies (hospital beds, Hoyer lifts, air filters, and essential household furnishings)

Restrictions/Limitations

• Services do not include the provision of Room and Board or payment of rental assistance.
• Services are not subject to the Room and Board provisions in Section IV of the DHCS Community Supports Policy Guide Volume 2.
• Actions taken under Housing Deposits must be identified as reasonable and necessary in the Member’s housing support plan.
• Service duration can be as long as necessary, and there is no limit on how many times an eligible Member may be authorized for this service.
• While it is optimal for Members to receive Housing Transition Navigation Services (HTNS) prior to Housing Deposits and/or Transitional Rent, it is not a prerequisite.

In this program, CenCal Health helps members at risk of losing their housing keep their housing and ensure it remains safe and stable.

The services in this program include:

• Offering education on tenant rights and responsibilities
• Coaching on how to be a successful tenant
• Coaching on independent living and life skills
• Working with the landlord on any issues
• Assistance resolving disputes with landlords or neighbors to avoid eviction
• Referrals to community resources to prevent eviction
• Help obtaining reasonable accommodations if needed
• Assistance completing applications for other benefits
• Help with the annual housing recertification process
• Creating a personal housing support and crisis plan
• Providing health and safety visits

Restrictions/Limitations

• Services do not include the provision of Room and Board.
• Services are not subject to the Room and Board provisions in Section IV of the DHCS Community Supports Policy Guide Volume 2.

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 housing preferences and barriers to stable housing
• Creating a personal housing support and crisis plan
• Searching for housing and providing options
• Assistance completing housing applications
• Help signing up for other benefits
• Finding resources to cover expenses such as security deposits, moving costs, and other one-time needs
• Assistance obtaining reasonable accommodations, if necessary
• Working with landlords on behalf of the member
• Ensuring the living space is safe
• Setting up transportation services when needed

Restrictions/Limitations

• Services do not include the provision of Room and Board or payment of rental assistance.
• Services are not subject to the Room and Board provisions in Section IV of the DHCS Community Supports Policy Guide Volume 2.
• Actions taken under Housing Transition Navigation Services must be identified as reasonable and necessary in the member’s housing support plan.
• Service duration can be as long as necessary, and there is no limit on how many times an eligible member may be authorized for this service.
• While it is optimal for members to receive HTNS before Housing Deposits and/or Transitional Rent, it is not a prerequisite.

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

Restrictions/Limitations

• Service covers up to two (2) meals and/or meal packages per day using a combination of Medically Tailored Meals (MTM) and Medically Supportive Food (MSF) interventions.
• MTM/MSF can be authorized for up to 12 weeks and may be reauthorized afterward if medically necessary.
• CenCal Health and its MTM/MSF providers are encouraged to check in with members receiving this Community Support frequently to assess whether members are obtaining and eating the foods/meals provided and whether any changes are needed to improve the effectiveness of the intervention.
• Meals, food, payments, and nutrition services eligible for or reimbursed by alternate programs cannot be funded or counted as MTM/MSF Community Supports.
• Since MTM/MSF services are part of clinical care to address nutrition needs related to chronic or serious health conditions, they cannot be used solely to respond to food insecurity.
• Because food and nutrition insecurity commonly coexist with chronic health conditions, DHCS encourages screening for food insecurity and facilitating access to additional resources such as SNAP, WIC, or local food pantries.
• DHCS does not consider food assistance benefits (SNAP, WIC) to be duplicative of MTM/MSF because those programs mitigate household-level food insecurity, whereas MTM/MSF services are medically tailored for the individual member’s clinical needs.

In this program, CenCal Health helps members who need support 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 remain safely 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
• Assistance attending doctor appointments
• Laundry

Restrictions/Limitations

• This service cannot be used in place of referring a member to the In-Home Supportive Services (IHSS) program. Members must be referred to IHSS when they meet referral criteria.
• If a member receiving Personal Care and Homemaker Services experiences any change in condition, they must be referred to IHSS for reassessment and determination of additional hours.
• Members may continue to receive Personal Care and Homemaker Services during the IHSS reassessment waiting period.

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 assistance with grooming, dressing, showering, meal preparation, taking medication, and getting in/out of bed
• Coordination of transportation to post-discharge medical appointments
• Connection to ongoing services a member may require, including mental health and substance use disorder services
• Support in accessing benefits and housing resources

Restrictions/Limitations

• Recuperative Care is an allowable Community Supports service only when necessary to achieve or maintain medical stability and prevent hospital admission or readmission, including when behavioral health interventions are required.
• Recuperative Care cannot exceed six (6) months per rolling 12-month period (though shorter authorizations may be provided based on member needs) and is subject to the six-month global cap on Room and Board services.
• Facility operators and staff providing Recuperative Care who are not licensed as Community Care Facilities may not directly assist members with Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).
• For members requiring ADL or IADL support in these facilities, CenCal Health may coordinate concurrent Personal Care and Homemaker Services or contract with a licensed third-party provider to furnish these services.

In this program, CenCal Health provides a member’s caregiver with short-term relief. It is designed for members who live in the community, need help with daily activities, and rely on a caregiver for most of their support to avoid placement in a care facility.

Children who previously received respite services under the pediatric palliative care waiver, foster care 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)

Restrictions/Limitations

• In the home setting, respite services—combined with any direct care services the member is receiving—may not exceed 24 hours per day of care.
• Service limit is up to 336 hours per calendar year. This includes both in-home and in-facility services.
• Exceptions to the 336-hour annual limit may be made with CenCal Health authorization when the caregiver experiences an event (such as medical treatment or hospitalization) that leaves the member without their caregiver. Respite provided during these episodes may be excluded from the annual limit.
• This service is intended only to avoid placements for which CenCal Health would be responsible.
• Respite services cannot be provided virtually or via telehealth.

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 a qualified health professional, and are exiting from Recuperative Care, inpatient hospitals (acute, psychiatric, or chemical dependency and recovery), residential substance use disorder or mental health treatment facilities, 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 accessing medical and/or behavioral health care

Restrictions/Limitations

• Short-Term Post-Hospitalization Housing cannot exceed six (6) months per rolling 12-month period, though shorter periods may be authorized based on individual needs.
• This service is subject to the six-month global cap on Room and Board services.

In this program, CenCal Health helps members who are 18 or older, are experiencing homelessness or do not have stable housing, and are publicly intoxicated from alcohol and/or other drugs find a safe place to sober up 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 care and dressing changes
• Shower and laundry facilities
• Substance use education and counseling
• Assistance connecting to other substance use disorder services
• Other needed health care services

Restrictions/Limitations

• This service is covered for a duration of less than 24 hours.

CenCal Health offers Transitional Rent in limited circumstances to support housing stability for eligible members. In this program, CenCal Health connects 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 six-month 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

Restrictions/Limitations

For more information on Transitional Rent Community Support, including restrictions and limitations, you may visit CenCal Health’s website at:

www.cencalhealth.org/members/calaim/