CALAIM COMMUNITY SUPPORTS
A clearer path from
referral to residential care
Know what to expect as you explore CalAIM Assisted Living Facility Transitions—from an initial conversation to a coordinated move.
Eligibility and service authorization are determined by the member’s health plan.
WHAT HAPPENS NEXT
From first conversation to move-in.
Every transition has different needs. These stages show the general path; some may overlap as the care team, health plan, member, and community coordinate.
STEP 01
Start the conversation
Contact Zeal or speak with the member’s case manager. Share the current setting, preferred area, and main questions so the right people can be involved.
STEP 02
Review eligibility and care needs
The health plan reviews benefit eligibility. The care team helps describe the support needed, while possible residential options are considered.
STEP 03
Prepare the referral
Gather the information requested by the plan and receiving community. Zeal can help clarify what is needed and how to share it through the appropriate secure channel.
STEP 04
Confirm authorization and fit
The health plan decides service authorization. The receiving community reviews whether it can meet the member’s needs. Discuss choices and costs before committing to a move.
STEP 05
Coordinate the transition
Once the necessary approvals and arrangements are in place, confirm the move-in plan, care handoff, transportation arrangements, and key contacts.
STEP 06
Settle in and stay connected
After the move, confirm who to contact about day-to-day care, follow-up questions, and any change in needs. Ongoing services follow the authorized care arrangement.
PEOPLE WORKING TOGETHER
A shared plan, with clear responsibilities.
You and your family
Bring your goals, preferences, questions, and concerns into the conversation.
The health plan and care team
Review eligibility, authorize services, and guide clinical decisions.
Zeal and the receiving community
Help coordinate the transition conversation and review the practical details of a possible placement.
A HELPFUL HEAD START
Bring the basics. We’ll explain the rest.
CONTACTS
Who should be involved?
Have the names of the member’s health plan, case manager, and family or authorized representative ready.
PREFERENCES
What matters for the move?
Think about location, language, daily routines, and the questions you want answered before choosing a community.
NEXT STEPS
What has already happened?
Let the team know whether a referral or authorization request is already underway so the conversation starts in the right place.
SETTING EXPECTATIONS
What affects the timeline?
A complete referral is one part of the process. Health-plan review, care needs, community availability, and move-in arrangements can all affect timing.
Ask who owns the next step, what is still outstanding, and when to follow up. A planned discharge date should be discussed with the care team early.
QUESTIONS, ANSWERED
A little more clarity
Can I choose a community?
Share your preferences early. Available options depend on care fit, the plan’s network, authorization, and current openings.
Should I send medical records through the contact form?
Use the contact form for a general inquiry. Ask the coordinator which secure method to use for records and referral documents.
What if the plan does not approve the request?
Ask the plan for the written reason and information about review or appeal options. Your care team can also discuss other available paths.
Ready to take the first step?
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.