CalAIM Program Information
Review the program details and eligibility requirements before starting an application.
Start with the CS Member Summary
This first form must be completed online. It establishes your application pathway and saves your progress securely to your account.
Complete or Upload Other Forms
After saving the summary, you can continue filling out other required forms online or upload signed copies. You can always return later to continue your progress.
Submit for Review
Once all the required forms for your chosen pathway are completed (either filled out online or uploaded), you will be able to submit the entire application package for review.
California Advancing and Innovating Medi-Cal (CalAIM) is a long-term initiative to transform and strengthen Medi-Cal, offering more coordinated and community-based care. There are 14 Community Supports, and the Assisted Living Transitions program is one of them. The Community Support (CS) for Assisted Living Transitions is a key part of this program. It gives eligible members the choice to reside in an assisted living setting—such as a Residential Care Facility for the Elderly (RCFE) or an Adult Residential Facility (ARF)—as a safe alternative to a skilled nursing facility, promoting greater independence and community integration.
Connections is a Community Support (CS) provider for the CalAIM program for Assisted Living Transitions. This CS enables members in skilled nursing facilities (SNFs) or in the community (e.g., at home) to transition to RCFE/ARFs. Connections assists with understanding the program, finding participating facilities, coordinating paperwork and assessments, and liaising with your Managed Care Plan to request authorization for the CS. Once a member is placed, we also send a MSW to visit the member at the RCFE/ARF for monthly quality control checks and provide ongoing care coordination. For any questions, please call us at (800) 330-5993.
Assisted living facilities come in various sizes, each offering a different environment. Connections can help you find a setting that best suits your needs:
- Small, Home-Like Settings: These are typically 4-6 bed homes that provide a high staff-to-resident ratio. This environment offers more personalized attention and a quieter, more intimate living experience.
- Large, Community Settings: These are often 100+ bed facilities that feature amenities like group dining rooms, a wide variety of planned activities, and social opportunities. Staff is available as needed to provide care and support.
SNF Transition to RCFE or ARF
This pathway enables a member to move from a Skilled Nursing Facility (SNF) to an assisted living community. To be eligible, a member must meet one of the following criteria:
- Currently in a SNF: Have resided in a SNF for at least 60 consecutive days. This can include a combination of Medicare and Medi-Cal days and transfers between a hospital and SNF.
- Recently Discharged: Resided in a SNF for at least 60 consecutive days and either applied for Community Supports while in the SNF, or was recently discharged to the community.
In addition, the member must also meet all of the following conditions:
- Be willing to live in an RCFE/ARF as an alternative to a SNF.
- Be able to safely reside in the new facility with appropriate support.
SNF Diversion to RCFE or ARF
This pathway helps a member who would otherwise need to move into a SNF to instead reside in an assisted living community. The member must:
- Be interested in remaining in the community.
- Be able to safely reside in an RCFE/ARF with cost-effective support.
- Be at a medically necessary SNF level of care or at risk of premature institutionalization.
A RN does an in-person visit (Kaiser) or virtual visit (Health Net) and reviews clinical notes, physician's report, medicine list and speaks with relevant skilled nursing facility/hospital social worker or family caregiver to determine tiered level of care (what the managed care plan pays to the RCFE/ARF).
The application process varies slightly depending on your health plan:
- For Health Net members: we will submit all pathway components (forms, ISP, name of RCFE/ARF) and submit it as a request for authorization. Most authorization request determinations are within 7-10 business days.
- For Kaiser members: there are two steps. Stage 1 involves the initial authorization request to determine if member will be authorized for the CS. Stage 2 involves compiling other package documents (including tiered level of care assessment) to determine "assisted living" rate paid to the RCFE/ARF. Authorization request determination timeframe varies by stages.
The member is responsible for paying for their own "room and board" at the RCFE/ARF. For members eligible for the 2025 Non-Medical Out of Home Care (NMOHC) payment, SSI/SSP is increased to $1,599.07. The member typically retains $179 for personal needs, with the remaining $1,420.07 going to the facility for room and board.
Example: If a member receives $500/month from SSI and they are eligible for the NMOHC, the SSI will increase to $1,599.07. From this total, they will pay $1,420.07 for room and board and keep $179 for personal expenses.
Members not eligible for the NMOHC will still have a "room and board" obligation but the amount could be flexible depending on the RCFE and the assessed tiered level.
Members who cannot pay for room and board are not eligible for this program.
Important
A signed document attesting to this financial obligation is included as part of every application pathway.
Managed Care Plans (MCPs) require proof of income to verify the ability to pay for "room and board." You will be required to upload one of the following documents later in the application pathway:
- The Social Security annual award letter showing the monthly benefit amount.
- Three (3) months of recent bank statements showing proof of Social Security income deposits.
Important
A signed document attesting to your proof of income is included as part of every application pathway.
Members with a Medi-Cal "Share of Cost" (a monthly deductible) may need to eliminate it to enroll in a Managed Medi-Cal plan that offers CalAIM. A share of cost works like a deductible, meaning you must pay a certain amount of your medical bills each month before Medi-Cal starts to pay. For more details on managing or eliminating your share of cost, please visit this resource page.
Connections is contracted as a Community Supports provider with the following Managed Care Plans (MCPs):
- Health Net: Serving members in Sacramento and Los Angeles counties.
- Kaiser Permanente: Serving members in various counties throughout California.
You must be a member of one of these plans to utilize our services for the CalAIM Community Support for Assisted Living Transitions.
To enroll in the CalAIM program through Connections, you must be a member of either Health Net or Kaiser. If you are currently in another Medi-Cal managed care plan, you will need to switch. You can change your health plan by contacting California Health Care Options at 1-800-430-4263 or visiting their website at www.healthcareoptions.dhcs.ca.gov. Changes must be made by the end of the month to be effective on the first day of the following month.
You have the right to file a complaint, also called a grievance or appeal, with your health plan. The Health Plan Member Services phone number is usually on the back of your health insurance card. You can file a grievance by phone or in writing at any time. Your health plan must resolve your grievance within 30 days. For more information on the process, please visit this resource page.