Guidance on Transitional Rent is out
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Melora Simon, MPH, Associate Director,
People-Centered Care
Governor Newsom’s latest budget (PDF) proposes several Medi-Cal cuts (PDF) for Californians without legal immigration status, including an enrollment freeze and premium requirements. It also reverses the elimination of the asset test introduced as part of CalAIM. Despite these cuts, the governor’s budget proposes doubling Community Supports spending in the coming year and increasing Enhanced Care Management spending by 30%. As negotiations progress over the coming month, we’ll be tracking the impacts to Medi-Cal overall and CalAIM in particular.
Highlights
Community Supports — updated policy guides and Transitional Rent details
Late last month, the California Department of Health Care Services rolled out new guidance around Community Supports. It’s in two parts: one includes guidance related to housing and homelessness, including the new Transitional Rent benefit. The other focuses on the remaining Community Supports.
Community-connected workers proving critical to CalAIM’s success
More than two-thirds of CalAIM implementers say they are employing community health workers and other community-connected workers to provide services — with positive results.
Closing behavioral health workforce gaps: assessing the impact of the “lay counselor” workforce
A new CHCF analysis highlights the impact of the Lay Counselor Academy, which is bridging gaps in the behavioral health workforce by training community-centered workers to provide low-barrier mental health care.
Community Supports — updated policy guides and Transitional Rent details
In late April, the California Department of Health Care Services (DHCS) released updated two-part guidance on Community Supports. One volume addresses housing and homelessness-related supports (PDF), while the other consolidates information on the remaining eight Community Supports (PDF).
The housing guidance includes Transitional Rent, which will become the 15th Community Support in California's Medi-Cal program on July 1, providing six months of rental assistance to qualifying members. MCPs have the option to offer this service initially. But in January 2026 it becomes a mandatory statewide benefit for eligible enrollees in the behavioral health population of focus, detailed on page 57 of the DHCS guidance (PDF). The housing guidance also introduces a six-month cap on room and board services, including recuperative care and short-term posthospitalization housing.
Earlier this month, DHCS shared a new cost impact analysis (PDF) of 12 of Medi-Cal’s Community Supports. The analysis found that nine of them show cost savings, and that three are expected to be cost-effective over time.
>> Read new DHCS guidance on Community Supports, both Volume 1 (PDF) and Volume 2 (PDF). See page 12 and 13 of this DHCS slide presentation (PDF) on Community Supports cost-effectiveness.
Community-connected workers proving critical to CalAIM’s success
It shouldn’t come as a surprise, but one of the biggest lessons learned from the first few years of CalAIM is how much the initiative’s success depends on the workforce that provides these expanded services.
California has taken bold steps to strengthen access to community-based care by expanding Medi-Cal coverage to three critical types of workers: community health workers/promotores/representatives (CHW/P/Rs), doulas, and behavioral health peer support specialists. More than two-thirds of CalAIM implementers (68%) in a recent CHCF survey say they employ at least one of these specialists to improve connections between health systems and the people they serve. Organizations that employ these workers not only have a more positive outlook on CalAIM, but they also see more positive results for the populations they serve.
A recent CHCF report (PDF) offers more details about how community-connected workers are covered through Medi-Cal, including provider requirements, billing codes, and service definitions. A collection of CHCF issue briefs also breaks down how the roles of these workers intersect and differ — as well as how these workers view themselves and the challenges they face.
An April webinar hosted by the Amplifying Impact Initiative offers more details about how organizations are effectively integrating community-connected workers into Enhanced Care Management models to provide culturally responsive health and social needs services. Over the next 18 months, Amplifying Impact will also be connecting 28 community-based care providers with grants, technical assistance, and other tools to continue scaling up this essential workforce.
>> Learn more about the community-connected care workforce in this CHCF report: Understanding California’s Community-Connected Workforce. More details about how CalAIM implementers are relying on these workers can be found in this CHCF survey: CalAIM Experiences: The Community-Connected Workforce. The Amplifying Impact Initiative webinar is viewable here: CHW/P/R Solutions for Enhanced Care Management.
Closing behavioral health workforce gaps: assessing the impact of the “lay counselor” workforce
Many community-based health and social services providers receive the same message when they encounter a patient struggling with mental health challenges: “In our current system, workers in these community settings are told to ‘refer, refer, refer’ when it comes to mental health issues,” says Elizabeth Morrison, cocreator of an innovative approach to filling gaps in the behavioral health workforce called the Lay Counselor Academy.
The problem, of course, is that California doesn’t have enough clinicians to meet this demand: A recent state survey (PDF) found one-third of Californians live in an area with an inadequate number of mental health professionals. A CHCF poll found 55% of Californians say they’ve experienced unreasonable wait times for mental health treatment — an issue that is even more acute for groups with the highest prevalence of mental illness, including children, adults of color, and families with low incomes.
The Lay Counselor Academy offers a solution. Since launching in 2022, this program has been training a diverse group of “lay counselors” — from community health workers and first responders to teachers and case managers — to provide crucial mental health counseling, without a clinical license.
A newly published CHCF analysis shows just how well the program is working: 74% of participants say the Lay Counselor Academy has improved their ability to help clients with mental health issues. Organizations with employees who have gone through the 65-hour training also report widespread benefits. One of the biggest: Integrating lay counselors into their behavioral health services has freed up licensed staff to focus on the highest-need cases.
Although most graduates of the program are incorporating the Lay Counselor Academy’s training into their current jobs, Morrison hopes the state will consider new payment structures that can allow this growing network of lay counselors to provide much-needed mental health care. “It feels maddening knowing that these individuals often have many of the skills to provide the care,” says Morrison. “We have a dream of a future without waiting lists.”
>> Read the full CHCF analysis of the Lay Counselor Academy: Strengthening the Behavioral Health Workforce: Evaluation of the Lay Counselor Academy. A recent CHCF article also profiled some LCA counselors and the work they are doing: New Workforce of Lay Counselors Strives to Bridge Mental Health Care Gaps.
Other CalAIM Articles and Resources We Recommend
- Implementers’ Perspectives on the Present and Future of Enhanced Care Management for Children and Youth (Lucile Packard Foundation for Children’s Health)
- The six-part CalAIM Academy for Hospitals and Health Systems, produced with CHCF support, is available online and for download. Hospitals and health systems interested in continued support as they implement CalAIM can fill out this short interest form to access free resources. (Communities Lifting Communities)
- Enhanced Care Management and Community Supports: Community Data Fact Sheets are available by county or Continuum of Care. (Homebase)
- How Medi-Cal Is Tackling Homelessness Through Innovative Housing Solutions (CHCF)
- Innovative Strategies in CalAIM Implementation: MidPen Housing Corporation (PDF) (Terner Center for Housing Innovation, UC Berkeley)
- Moving Home- and Community-Based Services to Medicaid Managed Long-Term Services and Supports: Considerations for California and Other Transitioning States (Center for Health Care Strategies)
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