Community Supports (CalAIM)
CalAIM Community Supports
Community Supports are services that help improve the health and well-being of Medi-Cal Managed Care Plan (MCP) Members by addressing health-related social needs. They serve as cost-effective, medically appropriate alternatives to traditional medical services or settings, such as hospitals or nursing facilities. The model includes 14 pre-approved services, such as housing transition, medically tailored meals, and respite care, which MCPs can optionally offer to their members.
Innovation
Allows Managed Care Plans to offer non-traditional, non-medical services (In Lieu of Services) like housing supports, medically tailored meals, and sobering centers as substitutes for traditional Medicaid State Plan services.
The Problem
Medi-Cal members face complex challenges affecting health, such as homelessness, unstable and/or unsafe housing, food insecurity, and/or other social needs that lead to higher, costlier levels of care like hospitalizations and nursing facility admissions.
The Solution
Providing a menu of 14 pre-approved Community Supports that substitute for covered Medi-Cal services as cost-effective alternatives, addressing social drivers of health (SDOH) to prevent the need for acute or institutional care.
Expected Outcomes
Improved health outcomes and quality of life for Medi-Cal members, reduced health disparities, and decreased need for hospital care, nursing facility care, and emergency department (ED) use.
Strategy
Aligns with the CalAIM goal of improving the quality of care and health outcomes of Medi-Cal Members by implementing delivery system, program, and payment reforms, specifically integrating physical, behavioral, developmental, and health-related social needs through a person-centered approach.
Model Goals
- Improve the health and well-being of MCP Members by addressing health-related social needs
- Help members live healthier lives
- Avoid higher, costlier levels of care such as hospital and nursing facility admissions
Patient Eligibility
Medi-Cal Managed Care members who meet specific criteria for each Community Support, such as being at risk of institutionalization, experiencing homelessness, having complex health needs, or requiring caregiver relief.
- Respite Services: Individuals dependent on a qualified caregiver who require caregiver relief to avoid institutional placement.
- ALF Transitions: Members residing in a nursing facility for 60+ days willing to transition, or community members at risk of institutionalization meeting nursing facility level of care.
- Community or Home Transition Services: Members receiving medically necessary nursing facility level of care for 60+ days choosing to transition home.
- PCHS: Individuals at risk for hospitalization or institutionalization, or with functional deficits and no other adequate support system.
- EAA: Individuals at risk for institutionalization in a nursing facility.
- MTM/MSF: Individuals with chronic or other serious health conditions that are nutrition-sensitive (e.g., diabetes, heart failure, cancer).
- Sobering Centers: Individuals ages 18 and older who are intoxicated but conscious, cooperative, and free from medical distress.
- Asthma Remediation: Members with poorly controlled asthma or a completed in-home environmental trigger assessment identifying medically appropriate remediations.
Provider Eligibility
Providers must have experience and expertise providing the unique services in a culturally and linguistically appropriate manner, and must be vetted and contracted by the Managed Care Plan (MCP).
- Must have experience delivering Community Supports services and an existing footprint in the communities they serve.
- Must enroll as Medi-Cal Providers if a state-level enrollment pathway is available (e.g., through PAVE).
- If no state-level pathway exists, MCPs must vet the provider's qualifications, business licensing, and capability to comply with reporting and oversight requirements.
- Must have the ability to receive referrals, submit claims/invoices using standardized protocols, and maintain a history free of fraud, waste, abuse, or criminal activity endangering members.
Care Categories
Caregiver Support
Transitions of Care
In-Home Support
Nutrition Support
Substance Use Support
Performance Metrics
Quarterly Unique Members Served
Total unique members (adults and children) utilizing Community Supports in 2025 Q2, representing a 13.3x growth since 2022 Q1.
Quarterly Services Utilized
Total number of Community Supports services utilized in 2025 Q2, reflecting a 13.7x increase from the 15,152 services utilized in 2022 Q1.
Cumulative Members Served
Cumulative number of unique members who have utilized Community Supports since program launch through 2025 Q2.
Cumulative Services Delivered
Total cumulative Community Supports services delivered since program launch through 2025 Q2.
Top Services by Member Volume
The most utilized Community Supports services by unique members over the last 12 months ending June 30, 2025.
Active Provider Contracts
Total number of active provider contracts for Community Supports in 2025 Q2, representing a 4.2x increase since 2022 Q1.
Cumulative Provider Contracts
Cumulative number of Community Supports provider contracts established since program launch through 2025 Q2.
Top Services by Provider Capacity
The Community Supports services with the highest number of contracted providers as of 2025 Q2.
Highest County Utilization Rates
Counties with the highest rate of Community Supports utilization per 10,000 Medi-Cal managed care members in the last 12 months.
Highest MCP Utilization Rates
Managed Care Plans with the highest rate of Community Supports utilization per 10,000 members in the last 12 months.
Membership and Demographics
This domain tracks the specific Medi-Cal members who have been approved for or received Community Supports. Sub-elements include member identification details (CIN, Name, Date of Birth) to monitor the characteristics of the population served.
Service Provision and Utilization
This domain monitors the actual delivery and authorization of specific Community Supports. MCPs must report sub-elements indicating exactly which of the predefined services (e.g., Housing Deposits, Recuperative Care, Sobering Centers) were approved for authorization and which were actually received by each member.
Provider Capacity
This domain evaluates the network adequacy and availability of Community Supports providers. Sub-elements include provider NPI, provider type, specific services offered, total number of members currently being served, and the total provider capacity to serve members.
Requests and Denials
This domain tracks the volume of incoming referrals and the rate of authorization rejections for Community Supports. Sub-elements include the number of unique members with requests from external sources and the number of those members determined ineligible or denied by the MCP.
Grievances and Appeals
This domain monitors member dissatisfaction and formal appeals specifically related to Community Supports. Sub-elements include CS-specific grievance and appeals data, which DHCS tracks via the revised Managed Care Program Data file to ensure beneficiary protections.
Operational Friction
Identified risk vectors and execution hurdles based on model structure.
Community Supports are optional in-lieu-of services (ILOS) that MCPs may choose to offer and for which individual members must be authorized. Unlike ECM, not every MCP offers every service — so the first friction is simply whether the member's MCP has elected the relevant service in their county.
DHCS monitors Community Supports through quarterly reports and the ILOS annual report. Service-level outcomes (inpatient cost reductions of -24.3% for Housing Trio, -21.4% for Medically Tailored Meals, -50.9% for Day Habilitation) depend on clean linkage between the service authorization, the CBO delivery record, and downstream Medi-Cal claims.
Each Community Support is authorized as a discrete, time-limited service (e.g. 6 months housing tenancy support, 12 weeks of medically tailored meals, a specific recuperative care stay). The financial window is the authorization period, and overruns or early terminations affect both MCP cost projections and CBO operating margins.
Community Supports succeed when MCPs, ECM teams, CBOs, hospitals, counties, and the member all see value. MCPs fund the service to reduce downstream medical cost; CBOs deliver for a per-unit payment; hospitals refer to speed discharge; counties want to reduce homeless services demand. Misaligned time horizons and payment structures fracture the handoff.
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