CalAIM for Assisted Living in California (2025 Guide): Eligibility, Costs, Benefits & How to Enroll

CalAIM for Assisted Living in California (2025 Guide) | Eligibility, Costs & Benefits

Learn how CalAIM’s Enhanced Care Management and Community Supports can help seniors transition to assisted living, how ALW differs, and what to do next.

What Is CalAIM?

CalAIM (California Advancing and Innovating Medi-Cal) is California’s multi-year initiative to improve outcomes and equity for Medi-Cal members by coordinating medical, behavioral, and social supports. The two parts most relevant to assisted living are:

  • Enhanced Care Management (ECM): a statewide Medi-Cal benefit that gives eligible members a single Lead Care Manager to coordinate care across settings.
  • Community Supports (CS): plan-elected, health-related services that address needs like transitions from facilities, housing navigation, and medically-tailored supports.

Together, ECM and Community Supports can help people avoid or leave institutional settings and live in the least restrictive environment possible—including assisted living when appropriate.

How CalAIM Connects to Assisted Living

The Community Support most directly tied to assisted living is Nursing Facility Transition/Diversion to Assisted Living Facilities (ALF). It funds services that help a member transition from a nursing facility to assisted living or divert a member from nursing facility placement into assisted living when safe and appropriate. Plans may also pair this with Community/Home Transition Services when a member is returning to a private home.

Important: Community Supports are plan-elected by county, which means not every plan in every county offers every support. Always check your plan’s elections and county availability.

Assisted Living Waiver (ALW) vs. CalAIM Community Supports

The Assisted Living Waiver (ALW) is a separate Home- and Community-Based Services waiver administered by DHCS. ALW pays for assisted-living services (care tiers) for Medi-Cal members who meet nursing-facility level of care and live in participating facilities—but it does not cover room and board. ALW can co-exist with CalAIM; members may use a Community Support to transition, then enroll in ALW for ongoing services.

Feature Assisted Living Waiver (ALW) CalAIM Community Supports (CS)
Program Type 1915(c) HCBS waiver Plan-elected Community Supports
Primary Use Ongoing assisted-living services for NF-level members Transition/diversion to ALF; one-time move-in or home setup supports
Who Pays Medi-Cal pays care tiers; resident pays room and board Managed care plan pays for authorized CS; room and board not covered
Availability Participating counties/facilities; limited slots Varies by plan elections and county
Provider Path Enroll as ALW provider Contract with local MCP as CS provider

Who Qualifies

  • Clinical need: Nursing-facility level of care is typical for ALW and for the NF Transition/Diversion to ALF Community Support.
  • Setting and timing: For Community/Home Transition Services, the member is moving from a facility to a home. For NF Transition/Diversion to ALF, the member is moving to or remaining in assisted living instead of a SNF.
  • Plan and geography: The member must be enrolled in a Medi-Cal Managed Care Plan that elects the relevant Community Support in their county.

What Services Can Be Covered

During Transitions

  • Care management and coordination
  • Housing navigation and application support
  • Move-in costs, deposits, furnishings, household setup
  • Transportation, accessibility items, one-time supports

In Assisted Living (NF → ALF)

  • Help with ADLs/IADLs and medication oversight
  • Ongoing support services in ALF setting
  • Coordination with providers and care teams

Room and board is not covered under Medi-Cal, whether ALW or Community Supports.

Availability by County and Plan

  1. Identify the member’s Medi-Cal plan and county.
  2. Check DHCS’s Community Supports Elections matrix to confirm which supports are offered.
  3. Call the plan to verify eligibility and referral steps.

For Providers: How to Participate

Assisted Living Operators

  1. Enroll in ALW and/or contract as a Community Supports provider with local MCPs.
  2. Negotiate rates with MCPs using DHCS guidance.
  3. Maintain NPI, staffing, data-sharing, and compliance systems.

Clinics and Community Organizations

  1. Become an ECM provider (or partner with one).
  2. Build referral pathways with hospitals, SNFs, and ALFs.
  3. Map local Community Supports and ALW slots; pre-screen members.

Costs: Who Pays for What?

  • Room and board: Not covered; residents or families are responsible.
  • Care and services:
    • ALW: Medi-Cal pays tiered daily rates; resident pays room and board.
    • Community Supports: MCP pays for authorized transition/diversion services; rates negotiated with plan.

Common Scenarios

Leaving a Nursing Facility for Assisted Living

Member’s plan authorizes NF Transition to ALF to support the move; if ALW slots are available, they may transition into ALW for ongoing services.

Preventing Nursing Facility Placement

Member in the community with increasing needs may be diverted to ALF via the same Community Support, if available.

Going Back to a Private Home

Plan may authorize Community/Home Transition Services plus other supports after discharge from a facility.

How to Get Started

  1. Confirm the Medi-Cal plan and county.
  2. Ask the plan if it offers NF Transition/Diversion to ALF or Community/Home Transition Services in your county.
  3. Request ECM if clinically appropriate.
  4. Explore ALW if available in your county.

FAQs

Does Medi-Cal pay for assisted living under CalAIM?

No. Medi-Cal does not cover room and board. CalAIM can cover transition services; ALW pays for care tiers, but residents pay room and board.

Do all plans offer the assisted-living Community Support?

No. Community Supports are elected by each plan, county by county. Check the DHCS matrix and confirm with the plan.

Can an assisted living facility bill the plan directly?

Yes, if contracted as a Community Supports provider. ALW providers must also enroll and follow ALW billing rules.

What about moving back home instead of assisted living?

Plans may authorize Community/Home Transition Services and related supports for members discharging to private residences.

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