Families sometimes wait because they believe only a doctor can “apply” for CalAIM. In practice, a member or authorized representative can ask the Medi-Cal plan about Community Supports, and care professionals may initiate or help submit a referral through the plan’s process. A hospital, skilled nursing facility, ECM care manager, primary-care office or Community Supports provider may also help. The important move is not finding a magic job title; it is locating the member’s plan pathway and making a trackable request.
Consent comes first
The member should be involved to the greatest extent possible. Confirm who may speak with the plan and what information may be shared before sending records.
Start with the member’s current coverage
Find the Medi-Cal managed care plan name on the current card or enrollment notice. Medicare coverage does not replace this step for a person who has both Medicare and Medi-Cal. Community Supports are delivered through the Medi-Cal plan.
Call the member-services number and use the current service name: “Assisted Living Facility Transitions.” Ask whether the plan offers the service in the member’s county, which department receives referrals and whether it uses a form, portal, fax or contracted partner.
Possible referral partners
A hospital case manager or SNF social-services team may be well positioned to describe the current setting and discharge needs. A primary-care or specialist office may provide clinical history. An ECM care manager can connect multiple systems. An RCFE operator can explain what the proposed setting can safely support.
No single participant should invent facts outside their role. The facility should not make the plan’s eligibility decision; the family should not be expected to interpret clinical records; and the plan needs more than a marketing brochure from the proposed residence.
- Member or authorized representative: preferences, history and permission to coordinate
- Clinical team: diagnoses, functional status, treatment and safety concerns
- Current setting: discharge needs and recent care observations
- Proposed RCFE: license, capabilities, availability and admission review
- Health plan: benefit review, authorization and notice
What to say in the first request
Keep the first message brief and specific. State that the member is requesting review for Assisted Living Facility Transitions, identify the current setting, explain the immediate reason for considering assisted living and ask for the required referral steps. Do not email medical records to a general address unless the plan has confirmed it is secure and appropriate.
Request a reference number, the date received and the name or department responsible for the next action. If a form is required, ask where to send it and how receipt will be confirmed.
If everyone thinks someone else submitted it
This is common during hospital and SNF transitions. Ask for evidence of submission rather than a verbal “we sent it.” Useful evidence includes a portal confirmation, fax receipt, secure-message record or plan reference number.
Create a one-line status note: “Referral submitted by ___ to ___ on ___; confirmation ___; next action owned by ___.” Share that note with the member and authorized participants. It turns a vague handoff into an accountable process.
Prepare before the plan calls back
Gather the member’s identifying and plan information, current location, primary contacts, functional needs, medication list and preferred geography. Do not delay the initial inquiry while collecting every document, but be ready to respond quickly when the reviewer identifies what is required.
Zeal’s transition review checklist provides a practical organization list.
Sources & important note
Zeal reviewed the primary sources below while preparing this article. Policies, benefits and individual circumstances can change; confirm current requirements with the responsible agency, health plan and licensed provider.
- DHCS: Community Supports Policy Guide, Volume 1
- DHCS: Medi-Cal Managed Care Health Plan Directory
- DHCS: Closed Loop Referral FAQ and information-sharing guidance
Editorially reviewed September 2026.