CALAIM COMMUNITY SUPPORTS
Could CalAIM support
your next step?
A practical starting point for Medi-Cal members, families, and care teams exploring assisted living through CalAIM.
Eligibility and service authorization are determined by the member’s health plan.
START WITH YOUR SITUATION
Eligibility begins with a review.
CalAIM Assisted Living Facility Transitions is a Community Support offered through participating Medi-Cal managed care plans. An inquiry helps identify the next step; it does not confirm coverage.
01 / HEALTH PLAN
Confirm your coverage
Ask your Medi-Cal plan whether Assisted Living Facility Transitions is available in your area and which providers are in its network.
02 / CARE NEEDS
Understand the level of support
Your care team and health plan review whether an assisted living setting can safely meet your needs.
03 / YOUR CHOICE
Find a setting that fits
Your willingness to live in assisted living, personal preferences, and the receiving community’s ability to support you all matter.
WHO MAY BE CONSIDERED
Two starting points. One individual review.
FROM A NURSING FACILITY
Considering a move into the community
The nursing-facility pathway includes members with a stay of 60 days or more who want to move to assisted living and can live there safely.
FROM THE COMMUNITY
Seeking an alternative to nursing care
Members who meet nursing-facility level-of-care criteria may be considered for assisted living instead. This can include people already living in an assisted living setting.
A hospital stay or short-term skilled nursing stay does not automatically rule someone out. Ask the health plan to review the applicable criteria.
UNDERSTANDING COSTS
Care support and living costs are different.
POTENTIAL COVERED SUPPORT
Transition and ongoing care
When authorized, this benefit can include help establishing an assisted living residence and ongoing assistance with daily living. The approved services depend on the member’s needs.
PLAN FOR SEPARATELY
Room and board
Room and board is excluded from this Community Support. Ask for a written explanation of housing costs, other charges, and any assistance available from separate sources.
The Assisted Living Waiver (ALW) is a separate program with its own enrollment process. Ask your care team which pathway is appropriate.
GETTING READY
A few details help the conversation.
HAVE HANDY
Health-plan information
Know the Medi-Cal plan name and a contact for the member’s care team. Keep identification and member numbers for the secure referral process.
THINK THROUGH
Current setting and priorities
Where is the member living now? What makes a move necessary? Note preferred locations, language needs, and the people who should join the discussion.
QUESTIONS, ANSWERED
A little more clarity
Does submitting an inquiry mean I qualify?
No. Your health plan makes the eligibility and authorization decision. Zeal can help you prepare questions and understand the next steps.
Can I ask about a family member?
Yes. Start with a general inquiry. We can explain how to involve the member or their authorized representative in the next conversation.
What if I’m not sure which program applies?
You do not need to sort that out alone. Tell us what you know about the current situation and we can help you identify who to speak with.
Let’s understand your options.
Tell us where you are in the process. We’ll help you understand the next conversation to have.
Please do not include medical records or sensitive health information in a general inquiry.