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What are Community Supports?

Community Supports (CS) are services or settings that may be offered in place of other covered services or settings. They are a medically appropriate, cost-effective alternative to a service covered under Molina. CS are optional – members are not required to use a CS instead of a covered service or setting.

Community Supports Offered:

DHCS offers a menu of fourteen (14) pre-approved CS to comprehensively address the needs of members, including those with the most complex challenges affecting health such as homelessness, unstable and unsafe housing, food insecurity, and/or other social needs.

The following are the CS services offered to Molina members who are enrolled in Medi-Cal only or Partial Duals (Medi-Cal with Medicare Part B and/or D), each one with specified criteria and limitations:

1. Housing Transition Navigation Services: Assists members experiencing homelessness with obtaining housing by providing support with items such as housing applications, benefits, advocacy, securing available resources, and providing help with landlords upon move-in.

   Criteria:
   • Prioritized for permanent supportive housing or rental subsidy; or
   • Experiencing homelessness; or
   • At risk of experiencing homelessness



2.  

   Housing Deposits: Assists members experiencing homelessness with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a person to establish a basic household that does not constitute rent.

    

   Criteria:
   • Currently enrolled in Housing Transition Navigation services; and
   • Prioritized for permanent supportive housing or rental subsidy; or
   • Experiencing homelessness
   
   Limitations: Services and resources are maxed at a total lifetime maximum amount of $5,000. Services may be approved one additional time with documentation as to what conditions have changed to demonstrate why providing Housing Deposits would be more successful on the second attempt.



3. Housing Tenancy and Sustaining Services: Provides tenancy and sustaining services to maintain safe and stable residency once housing is secured for members who had been experiencing homelessness and are now newly housed.

   Criteria:
   • Received Housing Transition Navigation services; or
   • Prioritized for permanent supportive housing or rental subsidy; or
   • Experiencing homelessness; or
   • At risk of experiencing homelessness
   
   Limitations: Only available for a single duration in the member’s lifetime. Services may be approved one additional time with documentation supporting change of conditions.



4. Short-Term Post-Hospitalization: Assists members who do not have a residence and who have a high medical or behavioral health needs with the opportunity to continue their medical/psychiatric/substance use disorder recovery immediately after exiting an inpatient hospital, residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care and avoid further utilization of State plan services.

   Criteria:
   • Has medical/behavioral health needs and would experience homelessness upon discharge from the hospital, substance use or mental health treatment facility, correctional facility, nursing facility, or recuperative care that would likely result in hospitalization, re-hospitalization, or institutional re-admission; and
   • Exiting Recuperative Care; or
   • Exiting an inpatient hospital stay (acute, psychiatric, or Chemical Dependency and Recovery hospital), residential substance use disorder treatment/recovery facility, residential mental health treatment facility, correctional facility, or nursing facility; and
   • Experiencing homelessness; or
   • At risk of experiencing homelessness
   
   Limitations: Only available for a single duration in the member’s lifetime maxed at 6 months.



5. Recuperative Care (Medical Respite): Assists members who need short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment.

   Criteria:
   • Requires short-term residential care to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment; and
   • At risk of hospitalization or is post-hospitalization and lives alone with no formal supports; or
   • At risk of hospitalization or is post-hospitalization and facing housing insecurity or have housing that would jeopardize their health and safety without modification; or
   • Experiencing homelessness; or
   • At risk of experiencing homelessness
   
   Limitations: Not to exceed more than 90 days in continuous duration



6. Respite Services: Provided to caregivers when it is useful and necessary to maintain a member in their own home and to preempt caregiver burnout to avoid institutional services. The services are provided on a short-term basis because of the absence or need for relief for the caregiver and are non-medical in nature. This service is rest for the caregiver only and only to avoid Long-Term Care placements.

   Criteria:
   • Lives in the community and is compromised in their Activities of Daily Living (ADLs) requiring dependency on a qualified caregiver; and
   • Member's qualified caregiver, who provides most of the member's support, requires caregiver relief to avoid institutional placement for the member; or
   • Member is a child who previously received Respite Services under the Pediatrics Palliative Care Waiver
   
   Limitations: The combination of all services the member is receiving cannot exceed 24 hours per day of care. Service limit is up to 336 hours per calendar year.



7. Day Habilitation Programs: Provide in an out-of-home, non-facility setting to assist members in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside successfully in the member’s natural environment.

   Criteria:
   • Experiencing homelessness; or
   • Exited homelessness and entered housing in the last 24 months; or
   • At risk of homelessness or institutionalization whose housing stability could be improved through participation in a day habilitation program



8. Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for the Elderly (RCFE) and Adult Residential Facilities (ARF): Assist individuals to live in the community and/or avoid institutionalization when possible. The goal is to both facilitate nursing facility transition back into a home-like, community setting and/or prevent skilled nursing admissions for members with an imminent need for nursing facility level of care (LOC).

   Criteria (Transition):
   • Has resided 60+ days in a nursing home; and
   • Willing to live in an assisted living setting as an alternative to a Nursing Facility; and
   • Able to reside safely in the community with appropriate and cost-effective supports and services
   
   Criteria (Diversion):
   • Is interested in remaining in the community; and
   • Is willing and able to reside safely in an assisted living facility with appropriate and cost-effective supports and services; and
   • Is receiving medically necessary nursing facility LOC or meets the minimum criteria to receive nursing facility LOC services and in lieu of going into a facility, is choosing to remain in the community and continue to receive medically necessary nursing facility LOC services at an Assisted Living Facility
   
   Limitations: Individuals are directly responsible for paying their own living expenses.



9. Community Transition Services/Nursing Facility Transition to a Home: Helps members who have been living in a skilled nursing facility to live in the community and avoid further institutionalization by supporting members with becoming newly housed and covering nonrecurring setup expenses.

   Criteria:
   • Currently receiving medically necessary nursing facility level of care (LOC) services and in lieu of remaining in the nursing facility or Medical Respite setting, is choosing to transition home and continue to receive medically necessary nursing facility LOC services; and
   • Lives 60+ days in a nursing home and/or Medical Respite setting; and
   • Is interested in moving back to the community; and
   • Is able to reside safely in the community with appropriate and cost-effective supports and services
   
   Limitations: Services and resources are maxed at a total lifetime maximum amount of $7,500. Services may be approved one additional time if the Member is compelled to move from a Provider-operated living arrangement to a living arrangement in a private residence through circumstances beyond his or her control.



10. Personal Care and Homemaker Services: Supports members who need assistance with Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).

    Criteria:
    • Needs assistance with ADLs and/or IADL tasks and has no other adequate support system; or
    • At risk for hospitalization or institutionalization in a nursing facility; and
    • Referred for IHSS and searching for a caregiver through the Public Authority registry; or
    • Currently receives IHSS and needs additional IHSS hours. The reassessment request is pending, and a caregiver is needed for support in the meantime; or
    • Not eligible for IHSS and needs services to help avoid a short-term stay in a skilled nursing facility (not to exceed 60 days)



11. Environmental Accessibility Adaptations (EAA) also known as Home Modifications: Physical adaptations to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home: without which the member would require institutionalization.

    Criteria:
    • At risk for institutionalization in a nursing facility; and
    • Has been conducted in accordance with applicable state and local building codes; and
    • Physical or occupational therapy evaluation and report provided to show medical necessity; and
    • Home visit conducted to determine the suitability of requested equipment or service
    
    Limitations: EAAs are payable up to a total lifetime maximum of $7,500. The only exceptions are if the Member’s place of residence changes or if the member’s condition has changed so significantly that additional modifications are necessary to ensure the health, welfare, and safety of the member, or are necessary to enable the member to function with greater independence in the home and avoid institutionalization or hospitalization.



12. Medically Tailored Meals: Provides meals to eligible members recently discharged from a hospital or skilled nursing facility.

    Criteria:
    • Recovering from hospitalization; or
    • Transitioning from nursing facility to home
    
    Limitations: Members who meet criteria will receive up to two (2) meals per day for up to four (4) weeks per hospitalization at a maximum of twelve (12) weeks in a calendar year.



13. Sobering Centers: Alternative destinations for members who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency department or jail.

    Criteria:
    • Individuals aged 18 and older who are intoxicated but conscious, cooperative, able to walk, nonviolent, and free from any medical distress (including life-threatening withdrawal symptoms or apparent underlying symptoms) and who would otherwise be transported to the emergency department or jail or who presented at an emergency department and are appropriate to be diverted to a Sobering Center.



14. Asthma Remediation: Assist members by identifying, coordinating, securing, or funding services and modifications necessary to a home environment to ensure the health, welfare, and safety of the individual or to enable the individual to function in the home and without which acute asthma episodes which could result in the need for emergency services and hospitalization.

    Criteria:
    • Individuals with poorly controlled asthma (as determined by an emergency department visit or Hospitalization or two sick or urgent care visits in the past 12 months or a score of 19 or lower on the Asthma Control Test) for whom a licensed health care provider has documented that the service will likely help avoid asthma-related hospitalizations, emergency department visits, or other high-cost services.
    
    Limitations: Services and resources are maxed at a total lifetime maximum amount of $7,500. Services may be approved one additional time if the member’s condition has changed so significantly that additional modifications are necessary to ensure the health, welfare, and safety of the member, or are necessary to enable the member to function with greater independence in the home and avoid institutionalization or hospitalization.

You can be referred to Community Supports by:

• ECM Provider
• Primary Care Physician/Clinic
• Specialists
• Molina Case Manager/ Transition of Care Coach
• Hospital/Skilled Nursing Facility
• Independent Medical Group (IPA) or Medical Group
• Self-Referral

Referrals for CS services can be made using the forms located on our website under Frequently Used Forms (molinahealthcare.com).

To find out if CS may be right for you, talk to your health care provider or call Member Services at 1-888-665-4621 (English) (TTY/TDD 711), Monday-Friday 7:00a.m.- 7:00p.m. The call is toll free.