CalAIM Community Support (CS) for Skilled Nursing Facility Diversion/Transition to Assisted Living

Through CalAIM, MCPs have the option of offering members the CS for Skilled Nursing Facility (SNF) Diversion/Transition to Assisted Living Home — aka as residential care facilities for the elderly or RCFEs. RCFEs in California are usually large 100+ bed assisted living homes (aka retirement homes) or small 4-6 bed residential care homes (aka board and care homes).

The goal of this CS is to promote skilled nursing facility (SNF) transition to RCFEs for eligible SNF residents on long term support and services (LTSS) and SNF diversion for individuals in the community at risk of premature institutionalization.

Eligibility:

For SNF transition:
1. Has resided 60+ days in a nursing facility; and
2. Willing to live in a RCFE as an alternative to a Nursing Facility; and
3. Able to reside safely in an RCFE with appropriate and cost effective supports; and
4. Must be on LTSS Medi-Cal.

For SNF diversion:
1. Interested in remaining in the community; and
2. Willing and able to reside safely in a RCFE with appropriate and cost-effective supports and services; and
3. Must be currently receiving medically necessary SNF level of care (LOC) or meet the minimum criteria to receive nursing facility LOC services and in lieu of going into a facility, is choosing to remain in the community and continue to receive medically necessary SNF LOC services at a RCFE.

“Room and Board” and “Assisted Living” Payment

RCFEs willing to accept MCP members will be paid from the combination of the member’s social security supplemental income (SSI) payment and social security supplemental payment (SSP) which pays for the “room and board” and the MCP “assisted living” payment (eventually reimbursed to the MCP through the CalAIM annual capitated rate calculations).

The 2023 SSI rate for a RCFE resident is $1,492.82. Of this amount, the resident retains $168 as the personal needs allowance and the balance $1,324.82 ($1,492.82-$168) is paid to the RCFE as the “room and board” payment.