Medi-Cal Programs

 

Kaiser Permanente offers 3 Medi-Cal programs:

  • Enhanced Care Management
  • Community Supports
  • Community Health Workers

These programs are for Medi-Cal members who have complex medical issues or need more 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 care teams. This includes doctors, specialists, and mental health providers.  They make sure everyone is working together and you get the care you need. A Lead Care Manager can also help you find services near you to help you stay healthy.

Enhanced Care Management services may include:

  • Coordinating care based on your specific medical and social needs
  • Helping you manage your medications
  • Helping you schedule appointments
  • Finding and applying for services near you
  • Helping you and your family improve your health

If you are already enrolled in Enhanced Care Management and would like to request a different ECM Lead Care Manager or ECM Provider, please contact one of our contracted ECM providers M-F 8:30am to 4pm.

Adults are eligible if: 1

  • 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
  • You are staying in a nursing home 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

Children or youth under 21 are eligible if: 1

  • 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 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 more social needs. This can include food, stable housing, transportation, or other needs. 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

1 Members may not be enrolled in ECM and any of the following programs at the same time: Hospice, Program for All-Inclusive Care for the Elderly (PACE), Complex Care Management (CCM), California Community Transitions (CCT), and 1915 (c) Home and Community-Based Services Waiver (HCBS) -- including Medi-Cal Waiver Program (HIV/AIDS), Home and Community-Based Alternatives (HCBA), Assisted Living Waiver (ALW), Home and Community-Based Services Waiver for the Developmentally Disabled (HCBS-DD), Multipurpose Senior Services Program (MSSP), and Self-Determination Program (ICF-DD).

Community Supports are services that help Medi‑Cal members with everyday needs that can affect your health, like housing or food. These services are covered by Medi‑Cal at no cost for eligible Kaiser Permanente members. You may be able to get Community Supports if you qualify and if the service is needed for your health and costs less than other Medi‑Cal services. 

Who can get Community Supports depends on the service. You can request services on your own, or your provider can refer you. You or your caregiver can contact Kaiser Permanente to learn which Community Supports you can get and what you need to qualify. Services usually start within 14 days after approval. You can find more details in the referral forms below. 

Different Community Supports are available depending on the county where you live.

Available in all counties

Housing Transition Navigation Services

Helps you find housing if you’re homeless or at risk of homelessness.

Housing Deposits

Help pay for a housing deposit and other move-in costs, so you can move into a home.

Housing Tenancy and Sustaining Services

Helps you maintain safe and stable housing once you have a place to live. Services may include education to prevent eviction and support with your duties and rights as at tenant.

Short-Term Post-Hospitalization Housing
Helps you keep getting better in residential care after leaving the hospital or another care setting. Available for up to six months.

Day Habilitation Programs

Helps you gain the skills needed to live in your community after experiencing homelessness or housing instability. Services may include mentoring on social skills, cooking, cleaning or managing money. 
Respite Services (for Caregivers)
Provides short‑term relief for caregivers, so you can take a break when needed. Offered by the hour, the day, or the night. 

Nursing Facility Transition/Diversion to Assisted Living Facilities

Helps you move from your home or a nursing facility into a home‑like place in your community where you can get help with daily activities.

Community Transition Services/Nursing Facility Transition to a Home

Helps you move from a nursing facility into a private home by helping pay for move‑in costs.
Personal Care and Homemaker Services
Helps you with daily activities so you can live at home. This can include help with bathing, dressing, grocery shopping  and preparing meals. This may also include someone to go with you to medical appointments.

Environmental Accessibility Adaptations (Home Modifications)

Helps make changes to your home, like adding wheelchair ramps or grab bars, so you can live safely and independently. 

Medically Tailored Meals/Medically Supportive Foods

Delivers healthy, cooked meals to your home after you leave a care facility. Meals match your health needs, such as special diets for diabetes.

Asthma Remediation

Helps you modify your home so you can live without acute asthma episodes. Changes include items like air filters and vacuums.

Recuperative Care (Medical Respite)

Provides a safe place for you to stay while you recover after leaving the hospital. Services may include housing, meals, and rides to medical or mental health appointments.

Transitional Rent

Helps pay for rent for up to six months to support you as you move from homelessness or being at risk of homelessness into permanent housing. Available to  members who receive behavioral health care. It may help to ask your county behavioral health provider for support with your request.

 

Available in some counties

Sobering Centers

Provides a safe and supportive place to help you become sober. Services may include meals, a temporary place to sleep, counseling, and help connecting to other health care services.2

 

More information about Community Supports services can be found on the DHCS website, including the Community Supports Fact Sheet

To find out which supports are available in your area, call us at the phone numbers listed below.

2 Available in all counties except Alameda, Contra Costa, Marin, Mariposa, San Mateo, Santa Cruz, Sonoma, Sutter and Yuba. 

Kaiser Permanente offers Community Health Worker (CHW) services at no cost to Medi-Cal members who qualify. A CHW is a non-clinical health professional. This means they are not a doctor, nurse, or social worker. They are a trusted member of your community who can help guide you through the healthcare system. They can offer you the support you need to reach your health goals. You may also know them as promotores, navigators or community health representatives. 

CHWs provide a wide range of support services. Here are some examples of how they can help you:

  • Provide cultural or language support to understand your healthcare options
  • Share information about your health condition
  • Guide you to government programs and local resources, like food or transportation
  • Go with you to doctor’s appointments
  • Support you with issues related to domestic or community violence

Community Health Worker services do not include:

  • Clinical services or other services that require a license
  • Childcare
  • Chores, such as shopping, cooking, or driving
  • Socializing or companion services
  • Employment services
  • Delivery of medication, medical equipment, or medical supplies

Most Medi-Cal members may qualify for CHW services. If you need non-clinical support to reach your health goals, you may qualify.

You are not eligible to receive CHW services if you are enrolled in Enhanced Care Management.

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.

Justice Involved Liaison

Kaiser Permanente’s Justice Involved Liaison (JIL) supports our members as they transition from incarceration into the community. The JIL coordinates care between correctional facilities, pre-release care management providers, and ECM providers. To contact our Justice Involved Liaison, email Ji-Liaison@kp.org or call 626-405-5386.

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