If your loved one has Medi-Cal and needs more help at home, you may have heard the term CalAIM but aren't sure what it means—or whether your family can actually receive in-home care through the program.
For eligible Medi-Cal members in San Diego County, CalAIM Community Supports may provide services that help people remain safe, supported, and independent at home.
That can include help with personal care, daily activities, homemaker tasks, and other support based on an individual's needs and their Medi-Cal managed care plan.
But not everyone with Medi-Cal automatically qualifies.
Here's what San Diego families should know about CalAIM in-home care eligibility, what services may be available, and how to get started.
What Is CalAIM and What Are
Community Supports?
CalAIM, or California Advancing and Innovating Medi-Cal, is a statewide initiative designed to transform Medi-Cal into a more coordinated, person-centered system of care.
Rather than focusing only on what happens in a doctor's office or hospital, CalAIM recognizes that factors such as housing, nutrition, safety, mobility, and support at home can also affect a person's health.
One part of CalAIM is called Community Supports.
Community Supports are services that participating Medi-Cal managed care plans can provide to eligible members when those services can help address health-related needs and support someone living safely in their community.
California's Department of Health Care Services (DHCS) lists Personal Care and Homemaker Services as one of the available Community Supports. These services can include help with activities of daily living and instrumental activities of daily living, such as bathing, feeding, meal preparation, grocery shopping, and accompaniment to medical appointments.
For a family caring for an aging parent or loved one, this can mean access to additional support at home without having to pay the entire cost out of pocket.
What Can CalAIM In-Home Care Cover?
The exact services available depend on the individual's needs, health plan, and authorization.
For eligible Coast Care clients, authorized Community Supports may include services such as:
Personal Care Assistance
Caregivers may help with everyday personal care activities, including:
- Bathing
- Dressing
- Grooming
- Mobility assistance
- Transfers and ambulation
- Other activities of daily living included in the authorized care plan
Homemaker Services
Support may also help maintain a safe and functional home environment, including:
- Meal preparation
- Laundry
- Light housekeeping
- Grocery shopping
- Errands
- Other approved household support
DHCS describes Personal Care and Homemaker Services as in-home support for members who need assistance with activities of daily living or instrumental activities of daily living.
Support for Complex or Chronic Conditions
Some people may need additional support because of chronic or complex health conditions.
At Coast Care, caregivers provide non-medical support for individuals living with conditions such as Alzheimer's, Parkinson's, and other chronic conditions. The specific services available through CalAIM depend on the member's authorization and care plan.
Support for Family Caregivers
Community Supports may also include caregiver-focused services, depending on the member's plan and circumstances.
For families already providing significant care, additional support can help make it more sustainable to keep a loved one at home.
Who Qualifies for CalAIM In-Home Care?
This is one of the most important things to understand:
Having Medi-Cal does not automatically mean someone qualifies for CalAIM in-home care.
CalAIM Community Supports are available to eligible Medi-Cal members through participating Medi-Cal managed care plans. The member must also meet the requirements for the specific Community Support being requested.
In San Diego County, eligibility and authorization are ultimately determined by the member's Medi-Cal managed care plan.
A person may be considered for Community Supports if they have needs such as:
- Difficulty with daily activities
- Functional limitations
- Chronic or complex health conditions
- A need for additional support to remain safely at home
- Risk of hospitalization
- Risk of nursing facility placement
- A caregiver who needs additional support
These circumstances do not guarantee approval. The health plan reviews the individual's situation and determines whether the requested service can be authorized.
Do you have to be enrolled in Enhanced Care Management?
No.
Community Supports and Enhanced Care Management (ECM) are related parts of CalAIM, but they are not the same benefit.
DHCS states that Community Supports are available to eligible Medi-Cal members and that members do not have to be enrolled in Enhanced Care Management to access Community Supports.
How to Apply for CalAIM In-Home Care in
San Diego?
If you think your loved one may qualify, you don't have to figure out the process alone.
Step 1: Confirm Medi-Cal and health plan enrollment
Start by confirming that your loved one has active Medi-Cal coverage and is enrolled in a participating Medi-Cal managed care plan.
Their health plan is ultimately responsible for determining eligibility and authorization.
Step 2: Talk to the health plan or care team
Ask whether CalAIM Community Supports, specifically Personal Care and Homemaker Services, may be appropriate.
You can also speak with:
- A health plan care manager
- An Enhanced Care Management provider
- A physician or healthcare provider
- A hospital discharge planner
- A social worker
- An authorized Community Supports provider
DHCS encourages members and their care teams to explore available Community Supports based on the individual's needs.
Step 3: Get a free eligibility screening
Coast Care offers a free phone screening for San Diego families who want to understand whether their loved one's situation may be appropriate for CalAIM Community Supports.
This screening can help you understand the next steps and what information may be needed.
It is important to remember that Coast Care does not determine eligibility or approve benefits. The member's Medi-Cal managed care plan makes the final eligibility and authorization decisions.
Step 4: Complete the assessment and authorization process
If Community Supports appear appropriate, the health plan evaluates the member's needs and determines whether services can be authorized.
Once services are authorized and a provider is selected, the provider can work with the health plan and care team to develop and deliver services according to the approved care plan.
At Coast Care, our team coordinates with health plans, care managers, healthcare providers, and families to deliver authorized services and keep everyone informed.
CalAIM In-Home Care vs. Paying Out of Pocket
One of the biggest questions families have is simple:
"How much will this cost me?"
For eligible Medi-Cal members whose Community Supports services are authorized by their health plan, the services may be provided at no cost to the member.
Coast Care specifically notes that eligible Medi-Cal members may receive authorized Community Supports services without paying the standard private-pay rate.
However, it's important not to assume that every person with Medi-Cal automatically receives free home care.
Community Supports are:
- Not automatically available to every Medi-Cal member
- Dependent on the member's managed care plan
- Subject to eligibility requirements
- Subject to health plan authorization
- Limited to approved services and care plans
In other words, Medi-Cal enrollment is the starting point—not a guarantee of CalAIM in-home care.
If someone does not qualify for CalAIM Community Supports, private-pay home care or another benefit may still be an option.
How Coast Care Helps San Diego Families
Navigating Medi-Cal benefits can be confusing, especially when you're already trying to coordinate care for someone you love.
Coast Care is a San Diego-based non-medical home care provider and an authorized CalAIM Community Supports provider.
Coast Care has been serving San Diego families since 2013 and is one of fewer than ten home care providers in the region with a CalAIM contract.
Our role is to provide authorized in-home services—not to make health plan eligibility decisions.
When a member is referred and approved for services, our caregivers can provide support with personal care, homemaker services, mobility, meals, companionship, and other approved needs according to the individual's care plan.
For families, that can mean having another experienced team helping coordinate the practical side of care at home.
Frequently Asked Questions About CalAIM
In-Home Care
Is CalAIM in-home care really free?
For an eligible Medi-Cal member whose Community Supports services have been authorized by their managed care plan, services may be provided at no cost to the member.
However, eligibility and authorization are determined by the health plan, and not every Medi-Cal member qualifies.
Can I choose my caregiver through CalAIM?
CalAIM Community Supports are delivered through authorized providers, so the process is different from IHSS, where an eligible recipient may select an individual provider.
If your priority is having a specific family member become a paid caregiver, IHSS may be the program to explore. CalAIM Community Supports are generally arranged through an authorized provider.
Read more: How to Get Paid to Care for a Family Member in California
How long does CalAIM approval take?
There is no single approval timeline that applies to every member.
The process can depend on the health plan, the type of Community Support being requested, the member's needs, required assessments, and authorization.
For that reason, families should ask their health plan or care team about the expected timeline for their individual case.
Does my loved one have to be at risk of going into a
nursing home?
Not necessarily.
Risk of nursing facility placement can be one reason Community Supports may be considered, but eligibility depends on the specific service, the member's circumstances, and the health plan's requirements.
A family should not assume that someone has to be on the verge of entering a nursing facility before asking about CalAIM.
Can someone receive IHSS and CalAIM?
Potentially, but the programs serve different purposes and have different rules.
CalAIM Community Supports are intended to supplement, rather than replace, other available services when applicable. DHCS guidance specifically notes that Personal Care and Homemaker Services cannot be used in place of referring a member to IHSS when an IHSS reassessment or additional hours may be appropriate.
If your loved one may qualify for both programs, it's important to discuss their situation with the appropriate program and health plan.
What if my loved one has Medi-Cal but isn't sure what health plan they have?
Start by checking their Medi-Cal plan information or contacting Medi-Cal or their health plan.
You can also contact Coast Care for a free screening, and our team can help explain the next steps for exploring CalAIM services.
Could Your Loved One Qualify for CalAIM
In-Home Care?
If your loved one has Medi-Cal and is struggling with daily activities, mobility, personal care, or safely managing life at home, it may be worth asking about CalAIM Community Supports.
You don't need to know exactly which service they need before reaching out.
The first step is simply understanding whether their needs may fit the program.
Coast Care provides a free phone screening for San Diego families interested in learning more about CalAIM Community Supports.
We'll help you understand the process, what information may be needed, and where to go next.