Long term services and supports are Medi-Cal benefits that help members with ongoing personal care needs. Molina Dual Options will work with the member's doctors and long term services and supports providers to arrange these services. If the member is not receiving these services now, Molina Dual Options will work with the member and their doctor to determine if they need services in the future. As a Molina Dual Options participant, members have access to the following long term services and supports (LTSS):
- Community Based Adult Services (CBAS)
- In Home Supportive Services (IHSS)
- Multi-purpose Senior Services Program (MSSP)
- Long Term Nursing Home Care
Community Based Adult Services (CBAS)
What is CBAS?
CBAS is a community-based day health program for older adults and adults with certain chronic medical, cognitive or mental health conditions, or disabilities who are at risk of needing institutional care. This program used to be called Adult Day Health Care (ADHC). CBAS providers must maintain an Adult Day Health Care (ADHC) license.
The primary objectives of the program are to:
- Restore or maintain optimal capacity for self-care to frail elderly persons or adults with disabilities; and
- Delay or prevent inappropriate or personally undesirable institutionalization.
- The Program stresses partnership with the participant, the family and/or caregiver, the primary care physician, and the community in working toward maintaining personal independence.
What services are included in CBAS?
CBAS core & Additional Services - Members may receive the following services on each day of attendance at a CBAS center:
- Professional nursing services
- Social services or personal care services
- Therapeutic activities
- One meal per day
Additional Services - Participants also receives any of the following services as specified in his/her Individualized Care Plan:
- Physical therapy
- Occupational therapy
- Speech therapy
- Mental health services
- Registered dietician services
- Transportation to and from the CBAS center to your home
How do Members get CBAS?
Participants Must Meet One of the Following Diagnostic Categories:
- NF-A level of care or above
- Chronic acquired or traumatic brain injury and/or chronic mental health
- Alzheimer's disease or other dementia (stage 5, 6, or 7)
- Mild cognitive impairment, including moderate Alzheimer's (stage 4 dementia)
- Developmental disability
- A physician, nurse practitioner or other health care provider, within his/her scope of practice, has requested CBAS services
- Member needs supervision or assistance with two or more of the following activities of daily living: bathing, dressing, self-feeding, toileting, ambulation, transferring, OR money management, accessing resources, meal preparation or transportation.
Molina Healthcare Services staff will work with the member and their doctor if they need this service. Molina Healthcare Services staff will complete face to face assessment to determine if member meets eligibility and medical necessity.
Provider Resources Materials
- CBAS Referral Request Process / Workflow
- CBAS Service Request Form
- CBAS Inquiry and Request form - SAMPLE CBAS
- Frequently Asked Questions (FAQ)
- Molina Healthcare Health Resources Contact List
- CBAS Referral Form
- Molina Healthcare of California Approved TARs for CBAS Services Form
Provider Training Materials
- Welcome Letter
- Introduction to Molina Healthcare Story
- CBAS New Provider Orientation
- Check List (NPO):
- Riverside - San Bernardino
- Los Angeles
- San Diego
- Molina Healthcare Claims Services - Claims Job Aid
In Home Supportive Services (IHSS)
What is IHSS?
IHSS helps pay for services that allow you to live safely in your own home. To be eligible you must be over 65 years of age, or disabled, or blind. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities.
What services are included in IHSS?
Members may receive the following services from IHSS:
- Meal preparation
- Grocery shopping
- Personal care services (such as bowel and bladder care, bathing, grooming and paramedical services)
- Accompaniment to medical appointments
- Protective supervision for mentally impaired
How do members get IHSS?
- The member must physically reside in the United States.
- The member must also be a California resident.
- The member must have a Medi-Cal eligibility determination.
- The member must live at home or an abode of their own choosing (acute care hospital, long-term care facilities, and licensed community care facilities are not considered "own home").
- The member must submit a Health Care Certification Form.
The member can also apply for IHSS by completing an application and submit it to their local county welfare department.
If the member receives IHSS now, their services will not change in the Molina Dual Options plan available through the State of California Cal MediConnect. The member will keep their IHSS providers and can still hire, fire and manage them. The county IHSS social worker will still assess the member's needs and approve their IHSS hours. The member's rights to appeal stay the same. Molina Healthcare Services staff can work with the member and their IHSS providers to help get the care they need.
Multi-Purpose Senior Services Program (MSSP)
MSSP helps the member work with their doctors, specialists, and other providers. It also helps the member get needed equipment and services. Multi-purpose Senior Services Program provides social and health care management for frail elders who are eligible for placement in a nursing facility but who wish to remain in the community. The goal of the program is to arrange for and monitor the use of community services to prevent or delay premature institutional placement of these frail clients. The services must be provided at a cost lower than that for nursing facility care.
Members may be eligible for care coordination help through the Multi-purpose Senior Services Program (MSSP) if they are 65 years of age or older, live within an MSSP site's service area, be able to be served within MSSP's cost limitations, be appropriate for care management services, currently eligible for Medi-Cal, and certified or certifiable for placement in a nursing facility. MSSP site staff make this certification determination based upon Medi-Cal criteria for placement.
What services are included in MSSP?
Members may receive the following services from MSSP.
- Adult day care
- Housing assistance
- Chore and personal care assistance
- Protective supervision
- Care management
- Respite for Caregivers
- Meal services
- Delivered Meals
- Social services
- Communications services
- Emergency Response System
- Minor Home Repairs
- Home Safety Modifications
- Home Medical Equipment
How do Members get MSSP?
Molina Healthcare Services staff will work with the member and their doctor if they need this service. Members can also contact the local MSSP site directly.
Long Term Nursing Home Care
What is long term nursing home care?
When Members are no longer able to safely live in their home due to a health condition, we will provide for their continued care in a nursing home.
What services are included in long term nursing home care?
If members qualify for long term care, they will receive all of the services provided by a nursing home.
How do members get long term nursing home care?
Molina Healthcare Services staff will work with the member's doctor and nursing home to better coordinate their care. If the member is in a nursing home now, they have a right not to change their nursing home for 12 months.