CalAIM Assisted Living Facility Transitions in 2026: What Changed—and What Did Not

Why the name changed

DHCS finalized a clearer service definition in its April 2025 Community Supports Policy Guide. The updated name puts the destination—an assisted living facility—front and center and removes language that could make families think the service applied only to people who had already spent a long time in a nursing facility.

For this Community Support, “assisted living facility” is an umbrella term that can include a licensed Residential Care Facility for the Elderly (RCFE) or Adult Residential Facility (ARF). In everyday conversation, families may also hear “assisted living,” “board and care,” or “residential care.” The license type and the home’s ability to meet the member’s needs matter more than the marketing label.

What the service is designed to do

The program is intended for members who meet the applicable nursing-facility level-of-care criteria and can live safely in an assisted living setting. Depending on the member and the authorization, support can include planning the move, coordinating with the current setting and receiving community-based assisted living services after placement.

A transition is not simply a referral to an open bed. The plan must consider clinical and functional needs, safety, the member’s preferences, the proposed facility and the service plan. A good referral makes those pieces visible instead of relying on a diagnosis alone.

• Members may be considered from a nursing facility, a hospital or short-term skilled stay, a private home, public subsidized housing or an existing assisted living setting when the policy criteria are met.
• The member must be willing to receive the service and able to live safely in the proposed setting.
• The Medi-Cal managed care plan—not Zeal or the facility—makes the authorization decision.

What did not change

Room and board remain outside this Community Support. Families should ask for a written explanation of what the plan-authorized service covers, what the residence charges for housing and meals, and whether any care-related fees remain the resident’s responsibility.

Availability also varies. Community Supports are delivered through Medi-Cal managed care plans and contracted providers, so a program name on a statewide page does not guarantee that every facility participates or that every member qualifies. Start with the member’s current plan and county, then confirm the provider pathway.

How to use current information without chasing every update

DHCS posts final policy guides, implementation resources and separate proposed updates. That distinction matters. A proposal can signal where policy may be heading, but it should not be presented to a family as an active benefit rule until DHCS finalizes it.

When a referral is underway, record the date and title of the guidance being used, the plan contact, the service name on the request and any reference number. If language changes during the process, those notes make it easier to understand whether the request itself changed or only the terminology.

A practical next step

Ask the plan or care coordinator one direct question: “Are you reviewing this request under Assisted Living Facility Transitions in the current Community Supports Policy Guide?” Then confirm the documents still needed, who owns the next action and when the family should expect an update.

If you are just starting, Zeal’s eligibility overview and process page explain the broader pathway without treating general criteria as a promise of approval.