Unlocking New Care Options: Understanding CalAIM, ECM, and the Assisted Living Waiver in San Diego

Navigating the world of senior care and Medi-Cal benefits can be complex. At Stellar Care, we believe in empowering our community with the right information to access quality residential living. California has introduced new programs to help those with complex needs receive the support they deserve in the most home-like setting possible. This guide breaks down key Medi-Cal benefits like CalAIM, Enhanced Care Management (ECM), and the Assisted Living Waiver (ALW) to help you understand your options.

What is CalAIM?

CalAIM is a Medi-Cal benefit designed to provide extra support for members with complex health or social needs, such as homelessness or serious mental health conditions. It recognizes that health goes beyond just medical care—it includes factors like housing, food access, and social services. The goal is to improve overall health and reduce costly emergency care by addressing these vital needs.

Enhanced Care Management (ECM): Personalized Support

For Medi-Cal members who need intensive support, Enhanced Care Management (ECM) connects them with a Lead Care Manager. This manager coordinates everything from medical appointments to social services.

• Who is it for? ECM is for high-need Medi-Cal members. You must have active Medi-Cal coverage, be enrolled in a Medi-Cal Managed Care Plan, and meet specific eligibility criteria.
• What does it provide? Members receive 7 core services based on their needs, including comprehensive assessment, care coordination, health promotion, and family support.

Community Supports (CS): Help Beyond the Hospital

Community Supports (CS) are services that address health-related social needs so members can live healthier lives. These services offer cost-effective alternatives to higher levels of care. These services are available to many Medi-Cal members and do not require enrollment in ECM. Examples of Community Supports include:

• Assisted Living Services: Subsidized care and housing in an assisted living community.
• Housing Support: Help with deposits, utilities, and sustaining housing.
• Recovery & Healing: Respite care, sobering centers, and short-term post-hospital housing.
• Care at Home: Personal care, homemaker services, and asthma remediation.
• Healthy Food: Home-delivered, medically tailored meals.

The Assisted Living Waiver (ALW) vs. Community Supports

Both ALW and CS help Medi-Cal members move from nursing facilities into assisted living communities, but they work differently.

Feature	Assisted Living Waiver (ALW)	Community Supports (CS)
Availability	Only in certain approved counties (San Diego is included)	Available statewide
Capacity	Capped slots with a waitlist (currently 2-3 years)	No caps
Model	Fee-for-services	Managed care benefits

Important Note: While the ALW program currently has a long waitlist of over 6,000 applicants, the CalAIM Community Supports Nursing Facility Transition/Diversion program is available now with no maximum capacity.

How to Access These Programs

These programs exist to help individuals who may be in a Skilled Nursing Facility (SNF) but don’t medically need to be there, or those who cannot be safe at home but lack the resources for private Assisted Living. Step-by-Step Guide to Applying:

1. Get Medi-Cal Approved: You must qualify for Medi-Cal coverage. Consultants like “The Light for Seniors” can assist with approval and annual renewals.
2. Enroll in a Health Plan: After approval, choose a San Diego Medi-Cal Health Plan within 30 days. If you do not select one, one will be assigned to you.Examples: Blue Shield Promise, Community Health Group, Kaiser Permanente, Molina Healthcare.
3. Connect with Your Provider: Work with your health plan to enroll in CalAIM Community Supports.
4. Choose a Care Coordination Agency (CCA): If pursuing the ALW, select a CCA to guide you through the application. Agencies like Calstro CCA are approved providers for both ALW and Community Supports.

Contact Stellar Care Today

At Stellar Care, we are committed to quality residential living and helping families find the right care solutions. Stellar Care – Assisted Living and Memory Care Facility Location: 4518 54th Street, San Diego, CA 92115 Phone: 619.287.2920 Email: brandonc@stellarcaresd.com Website: stellarcaresd.com