Community Health Group and CalAIM Assisted Living Transitions in San Diego County

Start by naming the exact service

CHG’s website may still use the earlier phrase “Nursing Facility Transition/Diversion to Assisted Living Facilities,” while current DHCS policy uses “Assisted Living Facility Transitions.” When calling or sending a referral, use both names if needed and state that the request concerns the Community Support for an assisted living or RCFE setting.

Do not use “CalAIM placement” as a catch-all. The health plan review, the residence’s admission assessment, Medi-Cal eligibility and the family’s room-and-board plan are separate decisions. Naming each action makes delays easier to find.

Who can help start the conversation

CHG encourages members to speak with their medical provider, social-service provider or Enhanced Care Management provider about Community Supports. A hospital or skilled nursing discharge planner, primary-care team, existing case manager, member or authorized representative may also help surface the need and connect with the plan’s referral process.

Ask who will actually submit the request, where supporting records must be sent and who will track the response. A verbal handoff without a named owner can leave every participant assuming someone else completed the referral.

• Confirm the member’s current CHG product and Member Services contact.
• Ask whether an ECM lead care manager is already assigned.
• Identify the current setting, discharge pressure and immediate safety concerns.
• Request the current CHG Community Supports referral form and submission instructions.

Build a clear functional picture

A diagnosis alone does not show whether assisted living is appropriate. The review should describe what the person can do independently, where cueing or hands-on help is needed and what happens at night or on a difficult day. Include mobility, transfers, bathing, dressing, toileting, eating, medication, cognition, behaviors and recent health-care use.

Specific observations are more useful than broad labels. “Needs supervision” becomes “forgets the walker, misses evening medication without cueing and has twice left the home after dark.” The proposed residence must then decide whether it can safely support those needs within its license and staffing model.

Separate authorization from residential costs

DHCS states that Assisted Living Facility Transitions exclude room and board. Families should ask CHG for a written explanation of the authorized service and ask the residence for an itemized admission agreement. Put housing, meals, care-level fees, medication assistance, supplies, transportation and optional services on separate rows.

Never rely on a general statement that assisted living is “covered.” Confirm the service, provider, effective dates, renewal expectations and resident responsibility. If something is unknown, assign one person to obtain a written answer before signing or paying a deposit.

Protect privacy during the referral

Medical records, member identification numbers and clinical documents should travel only through the plan’s or provider’s approved secure channel. Ordinary website forms and general email are appropriate for initial contact, not for sensitive health information.

Keep a simple referral log with the date, recipient, document name, confirmation number and next follow-up. That record helps a family or case manager ask precise questions without repeatedly resending the entire chart.

A Poway perspective from Huntington Manor

Huntington Manor works with Community Health Group and San Diego PACE when the resident, program and authorization are an appropriate match. Our team can explain the residential-care side of the process, but the health plan or PACE organization makes eligibility and coverage decisions. Families should confirm every approval and cost in writing.