Utilizing Medi-Cal’s Housing-Associated Providers to Stop and Finish Older Grownup Homelessness

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Utilizing Medi-Cal’s Housing-Associated Providers to Stop and Finish Older Grownup Homelessness


Desk of Contents

About this Useful resource

This useful resource is designed for housing and ageing service suppliers, advocates, and attorneys working with Medi-Cal eligible older adults who’re experiencing or vulnerable to homelessness. Recognizing that housing is a key social determinant of well being, California’s Medi-Cal program has inspired Medi-Cal Managed Care Plans (MCPs) to supply a spread of housing-related Neighborhood Helps. These helps are funded by Medi-Cal as a part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative.

This useful resource is meant to offer a high-level overview of the Medi-Cal companies accessible to forestall or finish older grownup homelessness, in addition to data on methods to acquire these companies. For extra data on Medi-Cal eligibility and extra background on Medi-Cal Neighborhood Helps please seek the advice of our reality sheet: Medi-Cal Insurance policies Enhancing Housing Safety Amongst Older Adults – Justice in Growing older.

Introduction

California’s low-income older adults are dealing with unprecedented housing instability, and older adults (age 50 and older) are the quickest rising age group experiencing homelessness.[1] Experiencing a interval of homelessness has extreme penalties for anybody’s general well being, and that is significantly true for older adults.[2] As soon as an older grownup turns into unhoused, their well being deteriorates quickly, they confront accelerated ageing, with their well being standing, power well being situations, and practical impairments akin to these of housed people who’re 20 years older. They’re at elevated danger of needing institutional ranges of care and dealing with untimely demise.[3] 

Medi-Cal Neighborhood Helps generally is a lifeline for older grownup purchasers who’re vulnerable to dropping their housing, or are at the moment experiencing homelessness.  

Neighborhood Helps are non-medical companies that Medi-Cal Managed Care Plans (MCPs) can supply to their members as substitutes for conventional lined well being companies.[4] MCPs contract with third get together Neighborhood Help suppliers to ship these companies to their members.[5] Neighborhood Helps are supposed to enhance well being outcomes by addressing the social determinants of well being, together with housing stability, meals safety, and different social wants.[6] Neighborhood Helps are non-obligatory for a plan to supply.[7] MCPs who elect to supply Neighborhood Helps can select from 14 companies pre-approved by the Division of Well being Care Providers (DHCS) that they could supply to their Medi-Cal members.[8] 

The seven Neighborhood Helps that help members experiencing or vulnerable to homelessness are listed under.

  1. Housing Transition and Navigation Providers – Assists members with discovering, making use of for, and acquiring housing.
  2. Housing Deposits – Assists members with figuring out, coordinating, securing, or funding one-time companies and modifications to determine tenancy, reminiscent of safety deposits, set-up charges for utilities, and protection of first month of utilities.
  3. Housing Tenancy and Sustaining Providers (HTSS) – Helps a member preserve a protected and steady tenancy as soon as housing is secured by companies like landlord communication, member schooling, and help with lease compliance.
  4. Day Habilitation Applications – Assists a member in buying, retaining, and bettering self-help, socialization, and adaptive expertise, like use of public transportation, battle decision expertise, and every day residing expertise.
  5. Recuperative Care (Medical Respite) – Gives a short-term keep in a residential setting for a member to get better from an damage or sickness.
  6. Quick-Time period Put up Hospitalization Housing – Gives members who’re exiting an institutional setting with the chance to proceed their restoration in a facility instantly after exiting the establishment.
  7. Transitional Lease (starting January 2026) – Gives as much as six months of rental help in interim or everlasting setting.

The primary three housing-related Neighborhood Helps are known as the “Housing Trio” and are supplied by each MCP in each county throughout the state.[9] These helps will not be time-limited, which means they don’t expire after a sure time period has handed, and may prolong till the MCP determines they’re not wanted.[10] Nonetheless, the Housing Deposit help is just accessible as soon as.[11] Aside from the Housing Deposit help, the Housing Trio doesn’t present every other monetary help for hire or room and board for Medi-Cal members.[12]

Variations by Plan and Location

Apart from Transitional Lease for particular populations, MCPs are inspired, however not required, to supply each Neighborhood Help. This implies an individual in a single county could have entry to Quick-Time period Put up-Hospitalization helps by their MCP however an individual in a neighboring county could not as a result of their MCP selected to not supply that help. Equally, two individuals in the identical county could have completely different Neighborhood Helps accessible to them if they’re in several MCPs. This inconsistency results in inequitable entry to the complete vary of helps throughout the state due to every MCP’s decisions or capability. This results in confusion and large variability relying on an individual’s geographic area and MCP. To find out which Neighborhood Help can be found, advocates can seek the advice of DHCS’s record of the Neighborhood Helps choices by every MCP and county.  

Starting in January 2026 a brand new housing help, Transitional Lease, might be accessible for individuals with critical power well being situations, bodily, mental, or developmental disabilities, or specialty behavioral well being wants, and who’re experiencing homelessness – or vulnerable to – and are transitioning out of sure settings like long-term care amenities, carceral settings, and different settings.[13] Transitional Lease might be necessary for MCPs to supply to individuals with behavioral well being wants and who meet different eligibility standards.[14] Plans have the possibility to increase Transitional Lease to different populations, together with these transitioning out of incarceration, out of interim housing, or institutional settings.[15] Transitional Lease can present as much as six months of rental help to eligible people.[16]

Federal Uncertainty

California supplies Neighborhood Helps by a mixture of federal waivers and authority to deal with well being associated social wants. In March 2025, the federal authorities restricted the authority permitting states to offer Medicaid funded companies to deal with well being associated social wants. Current approvals, reminiscent of in California, will not be rescinded and can stay in impact till they expire within the subsequent 1-4 years. Neighborhood Helps are nonetheless a Medi-Cal service as of the time of this publication. It is a coverage space that’s altering quickly and advocates ought to keep related through Justice in Growing older’s listserv.  

These housing-related Neighborhood Helps might be obtained concurrently and coordinated to realize housing stability, and will also be paired with non-housing Neighborhood Helps. A member can obtain Housing Deposits and Housing Transition and Navigation Providers on the similar time to safe housing. After housing is secured, they’ll obtain Housing Tenancy Sustaining Providers to assist preserve housing. Members may obtain each Housing Deposits and Transitional Lease on the similar time, if in help of the identical housing placement- Housing Deposit to safe the location and Transitional Lease for the month-to-month rental funds.

MCPs ought to contract with organizations which have expertise delivering companies to the neighborhood, organizations who’ve an current footprint within the communities they serve and are trusted messengers.[17] Shelters, road medication suppliers, well being facilities, homeless companies suppliers, recuperative care suppliers, supportive housing suppliers, Coordinated Entry Techniques (CES), county companies, and different service suppliers with expertise working with homeless people could also be contracted with the native MCP to function Neighborhood Help suppliers. Advocates can discover out who their Neighborhood Help suppliers are by consulting the native MCP’s listing of contracted well being care suppliers, which is required to be accessible for members for every MCP.[18]

Solely individuals receiving full-scope Medi-Cal and enrolled in a Medi-Cal MCP are eligible for Neighborhood Helps.[19] The Neighborhood Helps talked about on this FAQ are usually accessible to Medi-Cal members experiencing or vulnerable to homelessness.[20] MCPs and their contracted Neighborhood Help suppliers should adjust to the complete DHCS-established service definitions for every Neighborhood Help, with out modifications or restrictions.[21] MCPs will not be allowed to set extra restrictions or limitations on the Neighborhood Help service definitions.[22] Advocates ought to seek the advice of the DHCS Neighborhood Help Coverage Information Quantity 1 and Quantity 2 for detailed definitions and eligibility standards for every Neighborhood Help.

The MCPs are in a position to set up their very own nondiscriminatory referral and authorization procedures.[23] If an MCP has determined they are going to supply a service, the MCP will decide if the Neighborhood Help is a medically acceptable various to well being care companies lined underneath Medi-Cal and doc this course of.[24] An MCP would then authorize the Neighborhood Help service for a most variety of days or months as deemed wanted.[25]

Enhanced Care Administration (ECM) is the best degree of care administration supplied by MCPs.  ECM is separate from Neighborhood Helps however an individual could qualify to obtain each companies concurrently. Folks receiving ECM needs to be assessed for related Neighborhood Helps, together with housing-related helps, as a part of their case administration companies. Receipt of ECM, nonetheless, is just not a prerequisite for Neighborhood Helps. For extra data on ECM, please seek the advice of our extra sources, CalAIM Information for Older Adults and Medi-Cal Insurance policies Enhancing Housing Safety Amongst Older Adults – Justice in Growing older.

There are a selection of ways in which a Medi-Cal member might be related to a Neighborhood Help. MCPs should settle for referrals for Neighborhood Help companies from:

  • Members and their households, guardians and caregivers;
  • Well being care suppliers;
  • Neighborhood Help suppliers, and;
  • Different suppliers and Neighborhood-Primarily based Organizations.[26] 

DHCS expects that MCPs will set up sturdy referral relationships with native suppliers offering Neighborhood Helps and with a variety of organizations locally, and develop a course of for receiving and responding to referral requests from a variety of sources.[27] Nonetheless, if an advocate is working with a member who believes they’re eligible, the advocate can name the MCP to study extra about Neighborhood Helps and methods to request authorization. The MCP’s public dealing with web sites, member handbooks, and supplier directories will need to have present details about Neighborhood Helps and methods to entry them.[28]

As a result of Neighborhood Helps are well being advantages, a Medi-Cal member must undergo the MCP’s authorization course of to show that the Neighborhood Help is medically acceptable for the member.[29] This implies the MCP should doc how the Neighborhood Help is more likely to cut back or forestall the necessity for acute care or different Medi-Cal companies.[30] Sure Neighborhood Helps, reminiscent of Recuperative Care and Quick-Time period Put up-Hospitalization housing, can use an expedited authorization course of.

Advocacy Tip

Advocates may also help the referral course of by serving to Medi-Cal members collect paperwork to point out their eligibility for a selected Neighborhood Help. For instance, the Housing Trio requires proof of a critical power situation and/or critical psychological sickness and documented danger of institutionalization or requiring residential companies due to substance use dysfunction. If any of those paperwork will not be in possession of the MCP, advocates may also help collect this proof along side a referral.

A MCP’s determination concerning Neighborhood Helps is topic to the identical federal and state necessities for processing grievances and appeals as for different Medi-Cal well being companies.[31] MCPs are required to have a course of in place for graduating or discontinuing Neighborhood Helps for Medi-Cal members who not qualify for or require these companies.[32] As with different Medi-Cal companies, members who obtain Neighborhood Helps have the choice to file a grievance or enchantment if they’ve a dispute with the MCP concerning a service.

Grievance Course of

If a member, or an advocate for the member, information a grievance, the MCP should observe the federal laws concerning grievances.[33] By federal definition, a grievance is any expression of dissatisfaction about any matter aside from an hostile profit dedication.[34] Grievances could embrace, however will not be restricted to, the standard of care or companies offered, elements of interpersonal relationships reminiscent of rudeness of a supplier or worker, and the member’s proper to dispute an extension of time proposed by the MCP to make an authorization determination.[35] An inquiry or criticism will also be categorized as a grievance and handled accordingly.[36]

When a grievance is filed, the MCP should acknowledge receipt of the grievance. The MCP then has 30 calendar days to reply to the grievance.[37] The MCP’s response to the grievance should embrace a transparent rationalization of the MCP’s determination. There could also be grievance varieties that require a distinct response timeline so remember to seek the advice of state and federal legal guidelines and laws in case you are aiding a shopper with a grievance.

Attraction Course of

The enchantment course of is out there when the MCP has issued an “hostile profit dedication”.[38] This could embrace, however is just not restricted to, denial or termination of a requested service or beforehand approved service, together with dedication on kind or degree of service or medical necessity, discount of a beforehand approved service, and denial for fee of a service.[39]

An MCP should ship a written Discover of Motion for any hostile profit dedication made by the plan, until the member was knowledgeable at the start of service supply of the period of the service.[40] The Discover should embrace particular details about the adverse determination the MCP is making (denial, partial denial, termination of companies).[41] Extra Discover necessities exist if the denial or termination is because of a dedication that the service is just not medically vital. The Discover should additionally embrace a “Your Rights” attachment that informs the member of their enchantment and listening to rights.

Appeals should be filed inside 60 days of the Discover of Motion notifying the member of the plan’s hostile profit dedication.[42] For many selections, members should exhaust inner enchantment processes (usually the plan degree enchantment) earlier than continuing to a state listening to.[43] Nonetheless, if the MCP doesn’t observe the discover necessities, a member can request an inner enchantment or instantly file for a state listening to. When you have a shopper who must file an enchantment, it’s best to seek the advice of state legislation and laws to make sure that the MCPs has adopted all necessities and to make sure you are assembly all enchantment timelines.

Each appeals and grievances could also be filed in writing or by phone with the plan’s member companies division. It’s advisable to file written grievances and appeals to make sure all related data is precisely captured within the enchantment or grievance.

Advocacy Tip

In case you are a authorized advocate, you possibly can symbolize your shopper in interesting denials of a medically vital housing-related Neighborhood Help at both the plan degree enchantment or state truthful listening to. In case you are a neighborhood advocate, it’s best to refer your shopper to a authorized support group that may present recommendation and/or illustration. If advocates see systemic points, like sure MCPs not offering notices or lengthy delays in accessing companies, please notify us.

Neighborhood Helps generally is a priceless useful resource for older adults who’re experiencing or vulnerable to homelessness, however there’s nonetheless room to reinforce their general impactful. Efficiently accessing Neighborhood Helps depends upon sturdy coordination and a excessive degree of understanding between the well being care system and the homeless response system. Strengthening communication and collaboration between these two techniques is essential for advocates hoping to attach their purchasers to Neighborhood Helps.

Nonetheless, connecting purchasers to Neighborhood Helps is difficult as every Neighborhood Help has particular eligibility necessities, making it tough to evaluate whether or not a shopper might be approved to obtain the help. As a result of every County and MCP operates in another way, advocates working in a number of counties should familiarize themselves with every distinctive system. It’s essential that advocates keep away from screening out purchasers based mostly on assumptions about eligibility. As an alternative, advocates ought to set affordable expectations and deal with connecting purchasers to the MCP or Neighborhood Help supplier who can assess their eligibility.

Advocacy Tip

Advocates needs to be knowledgeable about their native MCP(s) course of for accepting referrals to and assessing for Neighborhood Helps. Advocates can work with the MCP(s) to assist develop the record of Neighborhood Help suppliers and referral organizations. If advocates have seen obstacles within the referral or screening course of, they need to look to affix native CalAIM or Medi-Cal stakeholder advisory conferences of their neighborhood to assist enhance this course of for older adults.

Conclusion

Medi-Cal’s Neighborhood Helps supply essential companies that may assist older adults keep away from homelessness or cut back the time they spend with out steady housing. Whereas these homeless prevention helps are very important parts of the homeless response system, they alone can’t remedy the disaster of older grownup homelessness. Present insurance policies and tips permit for vital variation in how companies are delivered throughout counties and MCPs, creating inconsistencies in entry and advantages. Navigating the well being care authorization course of will also be complicated and burdensome for each members and the native Neighborhood Help suppliers. Neighborhood Helps are an necessary device for combatting and stopping older grownup homelessness however can’t remedy for financial insecurity, the price of residing in California, and lack of inexpensive housing choices.

Regardless of these limitations, Neighborhood Helps symbolize a significant step towards extra built-in preventative options. With continued funding, stronger coordination, and dedication to increasing entry, Neighborhood Helps supply a possibility to strengthen the homeless response system and defend older adults from housing instability.

Endnotes

  1. Kushel, M. Moore, T., et al. UCSF Benioff Homelessness and Housing Initiative, Towards a New Understanding: The California Statewide Examine of Folks Experiencing Homelessness.(2023). p. 21. ↑

  2. Id. at p. 71. ↑

  3. Id. ↑

  4. See 42 C.F.R. § 438.3(e)(2); Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2: Neighborhood Helps to Help Members Experiencing or At Danger of Homelessness (Apr. 2025), p. 6. ↑

  5. Id. at p. 87. ↑

  6. See Cal. Dept. of Well being Care Providers, Transformation of Medi-Cal: Neighborhood Helps; see additionally Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025). ↑

  7. As of June 2023, each MCP serving Medi-Cal members within the state was offering housing-related Neighborhood Helps in some capability or getting ready to take action. See Cal. Dept. of Well being Care Providers, Neighborhood Helps Elections by MCP and County (Dec. 2024). ↑

  8. See Cal. Dept. of Well being Care Providers, Transformation of Medi-Cal: Neighborhood Helps; see additionally Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 1 and 2 (April 2025). ↑

  9. Cal. Well being Care Basis, Coverage at a Look, CalAIM’s Trio of Housing Neighborhood Helps: Navigation, Deposits, and Tenancy and Sustaining Providers (Mar. 2025). ↑

  10. See Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025). ↑

  11. As soon as per waiver demonstration interval. See Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025). ↑

  12. Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025). ↑

  13. Id. ↑

  14. See Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025), p. 57. ↑

  15. Id. at p. 61. ↑

  16. Id. at p. 57. ↑

  17. Id. at p. 87. ↑

  18. Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025), p. 82. ↑

  19. Folks residing locally with a Share of Price can’t be a part of Medi-Cal managed care plans and don’t qualify for Neighborhood Helps. See, Cal. Dept. of Well being Care Providers, Medi-Cal Managed Care Plans Necessary or Voluntary Enrollment by Medi-Cal Support Codes (2025). ↑

  20. See Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025). ↑

  21. See Id. ↑

  22. See Id. ↑

  23. Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025), p. 83. ↑

  24. Id. ↑

  25. UC Berkeley Terner Middle for Housing Innovation, Abt Affiliate, UCSF Benioff Homelessness and Housing Initiative, Understanding CalAIM Implementation Throughout the State (Feb. 2024,) p. 8. ↑

  26. Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025), p. 81. ↑

  27. Id. ↑

  28. Id. at p. 82. To seek out extra details about Neighborhood Help referral pathways, please go to DHCS’s web site. ↑

  29. Id. at. p. 83. ↑

  30. Id.; see additionally 42 C.F.R. §438.406; Welf. & Inst. Code §14197.3. ↑

  31. Cal. Dept. of Well being Care Providers, All Plan Letter 21-011 (August 2022). ↑

  32. Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025), p. 86. ↑

  33. Cal. Dept. of Well being Care Providers, All Plan Letter 21-011 (August 2022). ↑

  34. Id., citing 42 C.F.R. § 438.400(b). ↑

  35. Id. ↑

  36. Cal. Dept. of Well being Care Providers, All Plan Letter 21-011 (August 2022), citing Cal. Code Regs., tit. 28, § 1300.68, subd. (a)(1)-(2). ↑

  37. Cal. Dept. of Well being Care Providers, All Plan Letter 21-011 (August 2022). ↑

  38. Id., citing 42 C.F.R. § 438.400(b). ↑

  39. Id., citing Cal. Code Regs., tit. 28, § 1300.68, subd.(d)(4)-(5). ↑

  40. Cal. Dept. of Well being Care Providers, Neighborhood Helps Coverage Information Quantity 2 (April 2025), p. 86. ↑

  41. Cal. Dept. of Well being Care Providers, All Plan Letter 21-011 (August 2022). ↑

  42. Id. ↑

  43. Id. ↑



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