CalAIM Community Supports: Moving From a Nursing Facility to Assisted Living

CalAIM is the program through which California's Department of Health Care Services (DHCS) is changing how Medi-Cal works. One part of it is Community Supports: services that Medi-Cal managed care plans can provide to help members with health-related needs and avoid higher, costlier levels of care. DHCS has pre-approved a set of them and encourages every plan to offer as many as possible.

The word to notice is encourages. DHCS's policy guide describes these services as voluntary for a plan to cover and for a member to use. Each plan elects which ones it offers in each county, and DHCS publishes the list.

One of those services is the subject of this guide. DHCS now calls it Assisted Living Facility Transitions. Until 2025 its name was Nursing Facility Transition/Diversion to Assisted Living Facilities, and some DHCS pages and plan materials still use the old name.

DHCS's Community Supports Policy Guide, Volume 1, in the version updated April 2025, describes the goal: to help a member return from a nursing facility to a home-like setting, or avoid entering one, by living in an assisted living facility. For this service that means a residential care facility for the elderly (RCFE) or an adult residential facility, both licensed by the California Department of Social Services. It has two parts, and a plan that offers the service must offer both.

• Time-limited transition services. Assessing the member's housing and service needs and presenting options, helping secure a place in a home, including the applications and documents, moving expenses, and coordinating the move with the home. These end once the member is living there.
• Ongoing assisted living services. Help with daily activities, meal preparation, transportation, medication administration and oversight, companion services, social and recreational programs, and direct care staff on site 24 hours a day. The guide says a member can receive these for as long as he or she can maintain residency in the home.

The April 2025 policy guide describes two groups. The plan, not the care home, decides whether a member meets the criteria.

The first group is members living in a nursing facility who have been there 60 days or more, are willing to live in an assisted living setting as an alternative, and are able to live there safely.

The second group is members living in the community who want to stay there, are willing and able to live safely in an assisted living facility, and meet the minimum criteria for a nursing facility level of care. The guide counts a person already living in an assisted living home who is at risk of institutionalization as living in the community. It adds that a member in a hospital or on a short-term skilled nursing stay may be eligible if the other criteria are met.

All of this assumes the person has Medi-Cal through a managed care plan. California Advocates for Nursing Home Reform (CANHR) describes Community Supports as available to members who are eligible for Medi-Cal without a share of cost, or who can consistently meet their share of cost.

This service fills a real gap, but it is narrower than it sounds.

Families often hear about both programs in the same conversation. They are separate, but they can work in sequence. The policy guide gives the example of a member leaving a nursing facility who is waiting for waiver enrollment: he or she may use the transition services to make the move, then the ongoing services until waiver enrollment is complete. Our guide to the Medi-Cal Assisted Living Waiver explains that program and its waitlist.

No care home and no placement agency can approve this service. The request goes to the plan.

1. 1

   Find out which plan your relative is in

   Look at the Medi-Cal plan card or ask the nursing facility's business office. DHCS also has an online search tool that shows which Community Supports the plans in each county offer.

2. 2

   Ask the plan about Assisted Living Facility Transitions by name

   Use the old name too if the person on the phone does not recognize it. Ask whether the plan offers it in your county, what the eligibility rules are today, and how a referral is made.

3. 3

   Tell the nursing facility's social worker or discharge planner

   If your relative has a care manager through the plan's Enhanced Care Management benefit, the policy guide says that person coordinates referrals to Community Supports on the member's behalf.

4. 4

   Plan for room and board

   Ask the plan what your relative would pay the home each month and from what income. Our guide to SSI in board and care homes explains the rate many low-income residents rely on.

5. 5

   Ask to join the waiver waitlist as well

   A Care Coordination Agency takes the one-page waitlist request. CANHR describes very significant wait times.

Hamssa Benrekia is a senior living placement specialist in Torrance who works with families in the South Bay and Harbor area of Los Angeles County. She can share general information about CalAIM and the waiver, but she does not enroll anyone in a program, and the plan decides who is approved and which homes it will pay. She has worked alongside case workers and social workers when a relative was leaving a hospital or skilled nursing facility, and she can talk through whether a board and care home may fit the care needs and budget. To start, contact Hamssa. Related reading: moving from skilled nursing to assisted living and the California Assisted Living Placement Guide.