Table of Contents
About this Resource
This resource is designed for housing and aging service providers, advocates, and attorneys working with Medi-Cal eligible older adults who are experiencing or at risk of homelessness. Recognizing that housing is a key social determinant of health, California’s Medi-Cal program has encouraged Medi-Cal Managed Care Plans (MCPs) to offer a range of housing-related Community Supports. These supports are funded by Medi-Cal as part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative.
This resource is intended to provide a high-level overview of the Medi-Cal services available to prevent or end older adult homelessness, as well as information on how to obtain these services. For more information on Medi-Cal eligibility and additional background on Medi-Cal Community Supports please consult our fact sheet: Medi-Cal Policies Enhancing Housing Security Among Older Adults – Justice in Aging.
Introduction
California’s low-income older adults are facing unprecedented housing instability, and older adults (age 50 and older) are the fastest growing age group experiencing homelessness.[1] Experiencing a period of homelessness has severe consequences for anyone’s overall health, and this is particularly true for older adults.[2] Once an older adult becomes unhoused, their health deteriorates rapidly, they confront accelerated aging, with their health status, chronic health conditions, and functional impairments comparable to those of housed individuals who are 20 years older. They are at increased risk of needing institutional levels of care and facing premature death.[3]
Medi-Cal Community Supports can be a lifeline for older adult clients who are at risk of losing their housing, or are currently experiencing homelessness.
Community Supports are non-medical services that Medi-Cal Managed Care Plans (MCPs) can offer to their members as substitutes for traditional covered health services.[4] MCPs contract with third party Community Support providers to deliver these services to their members.[5] Community Supports are meant to improve health outcomes by addressing the social determinants of health, including housing stability, food security, and other social needs.[6] Community Supports are optional for a plan to offer.[7] MCPs who elect to offer Community Supports can choose from 14 services pre-approved by the Department of Health Care Services (DHCS) that they may offer to their Medi-Cal members.[8]
The seven Community Supports that support members experiencing or at risk of homelessness are listed below.
- Housing Transition and Navigation Services – Assists members with finding, applying for, and obtaining housing.
- Housing Deposits – Assists members with identifying, coordinating, securing, or funding one-time services and modifications to establish tenancy, such as security deposits, set-up fees for utilities, and coverage of first month of utilities.
- Housing Tenancy and Sustaining Services (HTSS) – Helps a member maintain a safe and stable tenancy once housing is secured through services like landlord communication, member education, and assistance with lease compliance.
- Day Habilitation Programs – Assists a member in acquiring, retaining, and improving self-help, socialization, and adaptive skills, like use of public transportation, conflict resolution skills, and daily living skills.
- Recuperative Care (Medical Respite) – Provides a short-term stay in a residential setting for a member to recover from an injury or illness.
- Short-Term Post Hospitalization Housing – Provides members who are exiting an institutional setting with the opportunity to continue their recovery in a facility immediately after exiting the institution.
- Transitional Rent (beginning January 2026) – Provides up to six months of rental assistance in interim or permanent setting.
The first three housing-related Community Supports are called the “Housing Trio” and are offered by every MCP in every county across the state.[9] These supports are not time-limited, meaning they do not expire after a certain period of time has passed, and can extend until the MCP determines they are no longer needed.[10] However, the Housing Deposit support is only available once.[11] Other than the Housing Deposit support, the Housing Trio does not provide any other financial assistance for rent or room and board for Medi-Cal members.[12]
Variations by Plan and Location
Except for Transitional Rent for specific populations, MCPs are encouraged, but not required, to offer every Community Support. This means a person in one county may have access to Short-Term Post-Hospitalization supports through their MCP but a person in a neighboring county may not because their MCP chose not to offer that support. Similarly, two people in the same county may have different Community Supports available to them if they are in different MCPs. This inconsistency leads to inequitable access to the full range of supports across the state because of each MCP’s choices or capacity. This leads to confusion and wide variability depending on a person’s geographic region and MCP. To determine which Community Support are available, advocates can consult DHCS’s list of the Community Supports offerings by each MCP and county.
Beginning in January 2026 a new housing support, Transitional Rent, will be available for people with serious chronic health conditions, physical, intellectual, or developmental disabilities, or specialty behavioral health needs, and who are experiencing homelessness – or at risk of – and are transitioning out of certain settings like long-term care facilities, carceral settings, and other settings.[13] Transitional Rent will be mandatory for MCPs to offer to people with behavioral health needs and who meet other eligibility criteria.[14] Plans have the option to extend Transitional Rent to other populations, including those transitioning out of incarceration, out of interim housing, or institutional settings.[15] Transitional Rent can provide up to six months of rental assistance to eligible individuals.[16]
Federal Uncertainty
California provides Community Supports through a mix of federal waivers and authority to address health related social needs. In March 2025, the federal government limited the authority allowing states to provide Medicaid funded services to address health related social needs. Existing approvals, such as in California, are not rescinded and will remain in effect until they expire in the next 1-4 years. Community Supports are still a Medi-Cal service as of the time of this publication. This is a policy area that is changing rapidly and advocates should stay connected via Justice in Aging’s listserv.
These housing-related Community Supports can be received simultaneously and coordinated to achieve housing stability, and can also be paired with non-housing Community Supports. A member can receive Housing Deposits and Housing Transition and Navigation Services at the same time to secure housing. After housing is secured, they can receive Housing Tenancy Sustaining Services to help maintain housing. Members can also receive both Housing Deposits and Transitional Rent at the same time, if in support of the same housing placement- Housing Deposit to secure the placement and Transitional Rent for the monthly rental payments.
MCPs should contract with organizations that have experience delivering services to the community, organizations who have an existing footprint in the communities they serve and are trusted messengers.[17] Shelters, street medicine providers, health centers, homeless services providers, recuperative care providers, supportive housing providers, Coordinated Entry Systems (CES), county agencies, and other service providers with experience working with homeless individuals may be contracted with the local MCP to serve as Community Support providers. Advocates can find out who their Community Support providers are by consulting the local MCP’s directory of contracted health care providers, which is required to be available for members for each MCP.[18]
Only people receiving full-scope Medi-Cal and enrolled in a Medi-Cal MCP are eligible for Community Supports.[19] The Community Supports mentioned in this FAQ are generally available to Medi-Cal members experiencing or at risk of homelessness.[20] MCPs and their contracted Community Support providers must comply with the full DHCS-established service definitions for each Community Support, without modifications or restrictions.[21] MCPs are not allowed to set additional restrictions or limitations on the Community Support service definitions.[22] Advocates should consult the DHCS Community Support Policy Guide Volume 1 and Volume 2 for detailed definitions and eligibility criteria for each Community Support.
The MCPs are able to establish their own nondiscriminatory referral and authorization procedures.[23] If an MCP has decided they will offer a service, the MCP will determine if the Community Support is a medically appropriate alternative to health care services covered under Medi-Cal and document this process.[24] An MCP would then authorize the Community Support service for a maximum number of days or months as deemed needed.[25]
What is the Link Between Enhanced Care Management and Community Supports?
Enhanced Care Management (ECM) is the highest level of care management offered by MCPs. ECM is separate from Community Supports but a person may qualify to receive both services simultaneously. People receiving ECM should be assessed for relevant Community Supports, including housing-related supports, as part of their case management services. Receipt of ECM, however, is not a prerequisite for Community Supports. For more information on ECM, please consult our additional resources, CalAIM Guide for Older Adults and Medi-Cal Policies Enhancing Housing Security Among Older Adults – Justice in Aging.
There are a variety of ways that a Medi-Cal member can be connected to a Community Support. MCPs must accept referrals for Community Support services from:
- Members and their families, guardians and caregivers;
- Health care providers;
- Community Support providers, and;
- Other providers and Community-Based Organizations.[26]
DHCS expects that MCPs will establish strong referral relationships with local providers providing Community Supports and with a wide range of organizations in the community, and develop a process for receiving and responding to referral requests from a wide range of sources.[27] However, if an advocate is working with a member who believes they are eligible, the advocate can call the MCP to learn more about Community Supports and how to request authorization. The MCP’s public facing websites, member handbooks, and provider directories must have current information about Community Supports and how to access them.[28]
Because Community Supports are health benefits, a Medi-Cal member will have to go through the MCP’s authorization process to prove that the Community Support is medically appropriate for the member.[29] This means the MCP must document how the Community Support is likely to reduce or prevent the need for acute care or other Medi-Cal services.[30] Certain Community Supports, such as Recuperative Care and Short-Term Post-Hospitalization housing, can use an expedited authorization process.
Advocacy Tip
Advocates can help the referral process by helping Medi-Cal members gather documents to show their eligibility for a specific Community Support. For example, the Housing Trio requires evidence of a serious chronic condition and/or serious mental illness and documented risk of institutionalization or requiring residential services because of substance use disorder. If any of these documents are not in possession of the MCP, advocates can help gather this evidence in conjunction with a referral.
A MCP’s decision regarding Community Supports is subject to the same federal and state requirements for processing grievances and appeals as for other Medi-Cal health services.[31] MCPs are required to have a process in place for graduating or discontinuing Community Supports for Medi-Cal members who no longer qualify for or require these services.[32] As with other Medi-Cal services, members who receive Community Supports have the option to file a grievance or appeal if they have a dispute with the MCP regarding a service.
Grievance Process
If a member, or an advocate for the member, files a grievance, the MCP must follow the federal regulations regarding grievances.[33] By federal definition, a grievance is any expression of dissatisfaction about any matter other than an adverse benefit determination.[34] Grievances may include, but are not limited to, the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a provider or employee, and the member’s right to dispute an extension of time proposed by the MCP to make an authorization decision.[35] An inquiry or complaint can also be categorized as a grievance and treated accordingly.[36]
When a grievance is filed, the MCP must acknowledge receipt of the grievance. The MCP then has 30 calendar days to respond to the grievance.[37] The MCP’s response to the grievance must include a clear explanation of the MCP’s decision. There may be grievance types that require a different response timeline so be sure to consult state and federal laws and regulations if you are assisting a client with a grievance.
Appeal Process
The appeal process is available when the MCP has issued an “adverse benefit determination”.[38] This can include, but is not limited to, denial or termination of a requested service or previously authorized service, including determination on type or level of service or medical necessity, reduction of a previously authorized service, and denial for payment of a service.[39]
An MCP must send a written Notice of Action for any adverse benefit determination made by the plan, unless the member was informed at the beginning of service delivery of the duration of the service.[40] The Notice must include specific information about the negative decision the MCP is making (denial, partial denial, termination of services).[41] Additional Notice requirements exist if the denial or termination is due to a determination that the service is not medically necessary. The Notice must also include a “Your Rights” attachment that informs the member of their appeal and hearing rights.
Appeals must be filed within 60 days of the Notice of Action notifying the member of the plan’s adverse benefit determination.[42] For most decisions, members must exhaust internal appeal processes (generally the plan level appeal) before proceeding to a state hearing.[43] However, if the MCP does not follow the notice requirements, a member can request an internal appeal or immediately file for a state hearing. If you have a client who needs to file an appeal, you should consult state law and regulations to ensure that the MCPs has followed all requirements and to ensure you are meeting all appeal timelines.
Both appeals and grievances may be filed in writing or by telephone with the plan’s member services department. It is advisable to file written grievances and appeals to ensure all relevant information is accurately captured in the appeal or grievance.
Advocacy Tip
If you are a legal advocate, you can represent your client in appealing denials of a medically necessary housing-related Community Support at either the plan level appeal or state fair hearing. If you are a community advocate, you should refer your client to a legal aid organization that can provide advice and/or representation. If advocates see systemic issues, like certain MCPs not providing notices or long delays in accessing services, please notify us.
Community Supports can be a valuable resource for older adults who are experiencing or at risk of homelessness, but there is still room to enhance their overall impactful. Successfully accessing Community Supports depends on strong coordination and a high level of understanding between the health care system and the homeless response system. Strengthening communication and collaboration between these two systems is crucial for advocates hoping to connect their clients to Community Supports.
However, connecting clients to Community Supports is challenging as each Community Support has specific eligibility requirements, making it difficult to assess whether a client will be authorized to receive the support. Because each County and MCP operates differently, advocates working in multiple counties must familiarize themselves with each unique system. It is crucial that advocates avoid screening out clients based on assumptions about eligibility. Instead, advocates should set reasonable expectations and focus on connecting clients to the MCP or Community Support provider who can assess their eligibility.
Advocacy Tip
Advocates should be informed about their local MCP(s) process for accepting referrals to and assessing for Community Supports. Advocates can work with the MCP(s) to help grow the list of Community Support providers and referral organizations. If advocates have noticed barriers in the referral or screening process, they should look to join local CalAIM or Medi-Cal stakeholder advisory meetings in their community to help improve this process for older adults.
Conclusion
Medi-Cal’s Community Supports offer crucial services that can help older adults avoid homelessness or reduce the time they spend without stable housing. While these homeless prevention supports are vital components of the homeless response system, they alone cannot solve the crisis of older adult homelessness. Current policies and guidelines allow for significant variation in how services are delivered across counties and MCPs, creating inconsistencies in access and benefits. Navigating the health care authorization process can also be complex and burdensome for both members and the local Community Support providers. Community Supports are an important tool for combatting and preventing older adult homelessness but cannot solve for economic insecurity, the cost of living in California, and lack of affordable housing options.
Despite these limitations, Community Supports represent a meaningful step toward more integrated preventative solutions. With continued investment, stronger coordination, and commitment to expanding access, Community Supports offer an opportunity to strengthen the homeless response system and protect older adults from housing instability.
Endnotes
Kushel, M. Moore, T., et al. UCSF Benioff Homelessness and Housing Initiative, Toward a New Understanding: The California Statewide Study of People Experiencing Homelessness.(2023). p. 21. ↑
Id. at p. 71. ↑
Id. ↑
See 42 C.F.R. § 438.3(e)(2); Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2: Community Supports to Support Members Experiencing or At Risk of Homelessness (Apr. 2025), p. 6. ↑
Id. at p. 87. ↑
See Cal. Dept. of Health Care Services, Transformation of Medi-Cal: Community Supports; see also Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025). ↑
As of June 2023, every MCP serving Medi-Cal members in the state was providing housing-related Community Supports in some capacity or preparing to do so. See Cal. Dept. of Health Care Services, Community Supports Elections by MCP and County (Dec. 2024). ↑
See Cal. Dept. of Health Care Services, Transformation of Medi-Cal: Community Supports; see also Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 1 and 2 (April 2025). ↑
Cal. Health Care Foundation, Policy at a Glance, CalAIM’s Trio of Housing Community Supports: Navigation, Deposits, and Tenancy and Sustaining Services (Mar. 2025). ↑
See Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025). ↑
Once per waiver demonstration period. See Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025). ↑
Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025). ↑
Id. ↑
See Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025), p. 57. ↑
Id. at p. 61. ↑
Id. at p. 57. ↑
Id. at p. 87. ↑
Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025), p. 82. ↑
People living in the community with a Share of Cost cannot join Medi-Cal managed care plans and do not qualify for Community Supports. See, Cal. Dept. of Health Care Services, Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment by Medi-Cal Aid Codes (2025). ↑
See Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025). ↑
See Id. ↑
See Id. ↑
Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025), p. 83. ↑
Id. ↑
UC Berkeley Terner Center for Housing Innovation, Abt Associate, UCSF Benioff Homelessness and Housing Initiative, Understanding CalAIM Implementation Across the State (Feb. 2024,) p. 8. ↑
Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025), p. 81. ↑
Id. ↑
Id. at p. 82. To find more information about Community Support referral pathways, please visit DHCS’s website. ↑
Id. at. p. 83. ↑
Id.; see also 42 C.F.R. §438.406; Welf. & Inst. Code §14197.3. ↑
Cal. Dept. of Health Care Services, All Plan Letter 21-011 (August 2022). ↑
Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025), p. 86. ↑
Cal. Dept. of Health Care Services, All Plan Letter 21-011 (August 2022). ↑
Id., citing 42 C.F.R. § 438.400(b). ↑
Id. ↑
Cal. Dept. of Health Care Services, All Plan Letter 21-011 (August 2022), citing Cal. Code Regs., tit. 28, § 1300.68, subd. (a)(1)-(2). ↑
Cal. Dept. of Health Care Services, All Plan Letter 21-011 (August 2022). ↑
Id., citing 42 C.F.R. § 438.400(b). ↑
Id., citing Cal. Code Regs., tit. 28, § 1300.68, subd.(d)(4)-(5). ↑
Cal. Dept. of Health Care Services, Community Supports Policy Guide Volume 2 (April 2025), p. 86. ↑
Cal. Dept. of Health Care Services, All Plan Letter 21-011 (August 2022). ↑
Id. ↑
Id. ↑
