Medi-Cal Programs

 

Kaiser Permanente offers three Medi-Cal programs:

  • Enhanced Care Management
  • Community Health Workers
  • Community Supports

These programs are for Medi-Cal members who have complex medical issues or need additional services and supports in the community.

Enhanced Care Management services help to coordinate your care. You will have a Lead Care Manager who will work with your doctors, specialists, mental health providers, and other care staff to make sure everyone is working together to get you the care you need. A Lead Care Manager can also help you find services in your community that can help keep you healthy.

Enhanced Care Management services may include:

  • Coordinating care based on your specific medical and social needs
  • Helping you understand and manage medications
  • Helping you schedule appointments
  • Finding and applying for services in your community
  • Working with you and your family to improve your health

Adults are eligible if:

  • You and your family are homeless or don’t have a stable place to live
  • You had 5 or more emergency visits, or 3 or more unplanned hospital and/or short-term skilled nursing facility (SNF) stays in the last 6 months
  • You have a serious mental health condition or struggle with drug or alcohol use
  • You are transitioning from incarceration
  • You are at risk of entering a nursing home or facility
  • You are staying in a nursing home or facility and need help to transition back to the community
  • You are pregnant or had a baby in the last year and are Black, American Indian, Alaska Native, or Pacific Islander (as of 1/1/2024)

Children or youth under 21 are eligible if:

  • You had 3 or more emergency visits, or 2 or more unplanned hospital and/or short-term SNF stays in the last 12 months
  • You have a serious emotional or mental health condition or struggle with drug or alcohol use
  • You are part of California Children’s Services (CCS) or Whole Child Model (WCM) and have additional social needs. This can include, but is not limited to food, stable housing, or transportation. Or you are having a mental health or substance use crisis. Or you had recent contact with police.
  • You are in foster care now or have a history of being in a child welfare program or foster care
  • You are transitioning from incarceration
  • You are pregnant or had a baby in the last year and are Black, American Indian, Alaska Native, or Pacific Islander
Community Supports are services that help with social factors that affect your health. These services help you in your community. They may help you find housing and other non-medical services.
Eligibility depends on the type of Community Support. You don’t have to be enrolled in Enhanced Care Management to receive Community Supports.

Kaiser Permanente offers different Community Supports for Medi-Cal members depending on the county where you live.

The following Community Supports are available:

Available in all counties

Housing Transition Navigation Services

Helps you find services for your housing needs. This could include finding housing if you’re homeless or at risk of homelessness.

Housing Deposits

Provides a housing deposit and other expenses to help you set up a home.

Housing Tenancy and Sustaining Services

Helps you keep safe and stable housing once you have a place to live. Services may include training, education, and coaching. You may also get support with your duties, rights, and benefits as a tenant.

Short-Term Post-Hospitalization Housing
Where you can continue to get better after being in the hospital. Also applies after being in other care settings. May include medical, psychiatric, or substance use issues.

Day Habilitation Programs

Helps you gain the skills and services needed to live in your community. Services may include mentoring. This can help you learn about jobs, manage money, and improve social skills.
Respite Services (For Caregivers)
Provides a brief break or relief for your caregiver.

Nursing Facility Transition/Diversion to Assisted Living Facilities

Helps you find a place to live in the community. The goal is to help you go from a nursing facility to a home-like setting.

Community Transition Services/Nursing Facility Transition to a Home

Helps you live and stay in the community. Helps with your costs to go from a nursing facility to a home where you’ll be responsible for your living costs.
Personal Care and Homemaker Services
Helps you with daily activities so you can live at home. This can include help with bathing, dressing, and feeding. You may also get help preparing meals, grocery shopping, and doing laundry. This may also include accompanied medical appointments.

Environmental Accessibility Adaptations (Home Modifications)

Helps you modify your home to ensure your health, wellbeing, and safety. These changes may help you live better at home independently.

Medically Tailored Meals/Medically Supportive Foods

Brings meals to your home after you leave the hospital. May also apply after you leave a nursing facility or at other critical times. Meals are tailored to your nutrition needs.

Asthma Remediation

Helps you modify your home to ensure your health, wellbeing, and safety. These changes can help you live in your home without acute asthma episodes.

 

Available in some counties

Recuperative Care (Medical Respite)

A safe place for you to recover for a short time after being in the hospital. You can get medical or behavioral health treatment while in a home-like setting.1

Sobering Centers

Where an intoxicated person may become sober. You may also be referred to services. These are safe and supportive places.2

If you have specific questions about availability of these supports in your area, reach out via the phone numbers below for additional information.

1 Available in all counties except San Mateo
Available in all counties except Contra Costa, Marin, Mariposa, Napa, Placer, San Mateo, Santa Cruz, Solano, Sonoma, Sutter, Ventura, Yolo

A CHW is a non-licensed, trusted member of the local community with lived or shared experience to the people they support. You may know them as promotores, navigators or community health representatives.

Community Health Worker services help you meet your health goals and coordinate care. CHWs can help you with a range of needs including:

  • Providing vetted information or instruction on health topics
  • Coaching and goal setting to improve your health or ability to self-manage health conditions
  • Accessing and understanding health care
  • Connecting to community resources and services including medical translation/interpretation, transportation services, or health related social needs
  • Having a cultural liaison
  • Performing outreach and resource coordination around preventive services
  • Helping with enrollment in government or other assistance programs
  • Providing peer support.

Community Health Worker services do not include:

  • Clinical case management or care management that requires a license
  • Child care
  • Chore services, including shopping and cooking meals
  • Companion services
  • Employment services
  • Delivery of medication, medical equipment, or medical supplies.

You may be eligible for Community Health Worker services if you:

  • Have one more chronic conditions (including mental health) OR exposure to violence and trauma
    and
  • Have challenges in meeting your health or additional needs.

You cannot receive CHW services through this benefit if you are already enrolled in Enhanced Care Management (ECM). This program includes services that a CHW would provide.

How can I enroll in Enhanced Care Management or get Community Supports or work with a Community Health Worker?

To learn more, call us Monday through Friday from 8:30 a.m. to 5 p.m.