California - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

California funds one-time institutional exit costs and coordination through the California Community Transitions (CCT) project, the Home and Community-Based Alternatives (HCBA) Waiver, and as a Community Support under CalAIM Medi-Cal Managed Care. The service, officially termed Community Transition Services or Nursing Facility transition care coordination, covers non-recurring set-up expenses and housing navigation to establish a basic household.

Approval requires contracting directly with Medi-Cal Managed Care Plans (MCPs) for CalAIM Community Supports or enrolling as a waiver provider through the Department of Health Care Services (DHCS). Applicants must pass an initial DHCS on-site assessment validating compliance with the HCBS Settings Final Rule before Medicaid enrollment is approved.

1. Service Definition and Scope

In California, Community Transition Services include time-limited transition coordination and non-recurring set-up expenses to enable a member to move from a licensed facility to a private residence or public subsidized housing. The service is designed to ensure the health, welfare, and safety of the member in the community.

Activities include assessing housing needs, communicating with landlords, securing required documentation, and funding essential household items or services not otherwise available under Medi-Cal.

• Target Population: Medi-Cal members who have lived 60+ days in a nursing home or recuperative care setting.
• Lifetime Maximum: Non-recurring set-up expenses are payable up to a total lifetime maximum amount of $7,500.00.
• Coordination Exclusion: The transitional coordination cost is excluded from the $7,500 total lifetime maximum.
• Covered Expenses: Pest eradication, one-time cleaning prior to occupancy, and necessary repairs to meet Housing Choice Voucher program quality standards.
• Covered Furnishings: Essential items such as an air conditioner or heater.

2. Regulatory and Oversight Agencies

The Department of Health Care Services (DHCS) is the single state agency overseeing Medi-Cal and administers the primary HCBS waivers and CalAIM programs. The Department of Developmental Services (DDS) oversees services for individuals with intellectual and developmental disabilities through the regional center system.

Medi-Cal Managed Care Plans, such as Health Net, authorize and oversee the delivery of these services when provided as a CalAIM Community Support.

• Department of Health Care Services (DHCS): https://www.ca.gov/departments/217/
• Department of Developmental Services (DDS): https://www.dds.ca.gov/initiatives/hcbs/
• Health Net (Medi-Cal Managed Care Plan): https://www.healthnet.com
• Medi-Cal Provider Enrollment (PAVE): https://pave.dhcs.ca.gov

3. Gatekeeping Prerequisites: Who Can Even Apply

California does not allow open, standalone enrollment for CalAIM Community Supports; providers must secure a contract directly with a designated Medi-Cal Managed Care Plan (MCP) operating in their county. Without an MCP contract, a provider cannot bill for CalAIM transition services.

For waiver-funded transition services, providers must pass a mandatory DHCS initial on-site assessment to validate compliance with the HCBS Settings Final Rule prior to approval. Providers serving the DD population must obtain Regional Center vendorization.

• Managed Care Contracting: Must secure a network contract with a Medi-Cal Managed Care Plan (e.g., Health Net) to provide CalAIM Community Supports.
• HCBS Settings Final Rule Validation: Must pass a DHCS initial on-site assessment confirming federal compliance before Medicaid enrollment is approved.
• Regional Center Vendorization: Required precondition for providers serving the HCBS-DD waiver population under Title 17.
• Duplication Restriction: Members cannot receive CalAIM Community Supports and waiver transition services simultaneously if activities are duplicative.

4. Licensure and Certification Requirements

California does not issue a distinct facility or agency license specifically for "Transitional Assistance Services." Instead, providers operate under standard local business licenses and must be certified by DHCS or vendorized by DDS as an HCBS waiver provider or contracted MCP entity.

Providers must demonstrate that their operational policies and physical settings (if applicable) comply with federal HCBS requirements, including freedom of choice and community integration.

• Business License: Standard local city/county business license required to operate a business in California.
• DHCS Certification: Required for participation in the Home and Community-Based Alternatives (HCBA) Waiver and Assisted Living Waiver (ALW).
• DDS Vendorization: Required for agencies contracting with local Regional Centers.
• HCBS Compliance: Must demonstrate protection of individuals' rights to privacy, dignity, and full access to the community.

5. Medicaid Provider Enrollment

Providers enrolling directly with the state for fee-for-service waiver programs must use the DHCS Provider Application and Validation for Enrollment (PAVE) portal. The enrollment process includes a comprehensive review of provider readiness and statutory compliance.

Providers contracting with MCPs for CalAIM must complete the specific credentialing and enrollment process dictated by each individual health plan.

• Enrollment Portal: DHCS PAVE system used for standard Medi-Cal provider enrollment.
• Application Form: Medi-Cal HCBS Eligibility Notice and standard enrollment applications.
• NPI Requirement: Must obtain and register a National Provider Identifier (NPI).
• Pre-Enrollment Validation: DHCS conducts initial on-site assessments to confirm Medicaid enrollment requirements are met prior to approval.

6. Staffing, Training and Background Checks

Staff providing transition coordination must be trained on person-centered planning and the specific regulatory criteria governing HCBS settings. Health Plan Health Coordinators and provider staff must understand how to document modifications to service plans.

Direct care and coordination staff are subject to standard California background check requirements, typically processed through the Department of Justice (DOJ).

• Background Checks: Department of Justice (DOJ) Live Scan fingerprinting required for staff with direct client contact.
• Training Requirement: Health Plan Health Coordinators and providers must be trained on regulatory criteria by the end of the transition period.
• Person-Centered Planning: Staff must be trained to document modifications to relevant regulatory criteria under 42 CFR 441.301(c)(2).
• Housing Expertise: Staff must be capable of assisting in searching for housing, completing applications, and securing required documentation (e.g., Social Security cards).

7. Documentation, Policies and Records

DHCS requires a comprehensive review of the applicant's policies and procedures to ensure they reflect all elements of the HCBS federal requirements. Providers must maintain detailed records of housing searches, landlord communications, and purchased items.

If found out of compliance during routine reviews, providers must submit a corrective action plan and generally implement corrections within 60 days.

• Policy Review: DHCS comprehensively reviews policies for compliance with freedom of choice, employment support, and privacy rights.
• Housing Documentation: Must secure and retain copies of member Social Security cards, birth certificates, and prior rental history.
• Service Plan Documentation: Person-centered service plans must document any modifications to relevant regulatory criteria.
• Corrective Action Plans: Must be submitted and implemented within 60 days if found out of compliance during routine monitoring.

8. Billing, Rates and Claims

Billing for Community Transition Services is routed either to the contracted Managed Care Plan (for CalAIM Community Supports) or to DHCS (for fee-for-service waiver claims). Services are capped by a strict lifetime maximum for set-up expenses.

Coordination time is billed separately from the hard costs of household goods and deposits, and is excluded from the lifetime expense cap.

• Lifetime Cap: $7,500 maximum for non-recurring set-up expenses.
• Coordination Exclusion: Transitional coordination costs are excluded from the $7,500 total lifetime maximum.
• Exception to Cap: Allowed only if the member is compelled to move from a provider-operated living arrangement due to circumstances beyond their control.
• Duplication Prohibition: Cannot bill for items or services otherwise available to the member under the Medi-Cal State Plan or another HCBS waiver.

9. Approval Sequence and Timeline

The approval sequence begins with submitting policies and procedures for state or MCP review, followed by an initial on-site assessment by DHCS or the designating entity. Providers must remediate any identified areas of non-compliance before final approval is granted.

For members, the transition period allowing them to receive services and establish their new household typically ranges between 90 and 365 days based on their unique circumstances.

• Policy Submission: Initial comprehensive review of provider policies and procedures by DHCS or DDS.
• On-Site Assessment: DHCS conducts initial on-site assessments to validate HCBS Settings Final Rule compliance.
• Remediation Phase: Providers work with the state to remediate areas of non-compliance prior to final enrollment.
• Member Transition Timeline: The transitional period for members varies in length, generally between 90 and 365 days.

10. Common Denials and Survey Findings

Applications are frequently denied or delayed when providers fail the DHCS initial on-site assessment for HCBS Settings Final Rule compliance, particularly regarding privacy and community access. Attempting to enroll without a required Managed Care Plan contract is a hard stop for CalAIM services.

During ongoing monitoring, common survey findings include failing to properly document person-centered service plans or billing for services that duplicate other Medi-Cal benefits.

• HCBS Non-Compliance: Failing to demonstrate protection of individuals' rights to privacy, dignity, and full community access.
• Incomplete Policies: Policies and procedures do not reflect all elements of the HCBS federal requirements.
• Duplication of Services: Billing for transition activities that are already covered under the State Plan or another concurrent program.
• Unapproved Settings: Attempting to transition members to housing that does not meet Housing Choice Voucher program quality standards.

11. Key Contacts and Resources

Providers should consult the Department of Health Care Services (DHCS) for waiver enrollment and CalAIM policy guidance. The Department of Developmental Services (DDS) is the primary contact for regional center vendorization.

Specific billing and authorization guides must be obtained directly from the contracted Medi-Cal Managed Care Plans, such as Health Net.

• Department of Health Care Services (DHCS): https://www.ca.gov/departments/217/
• Department of Developmental Services (DDS) HCBS Initiatives: https://www.dds.ca.gov/initiatives/hcbs/
• Health Net Provider Library: https://www.healthnet.com
• Medi-Cal Provider Enrollment Portal (PAVE): https://pave.dhcs.ca.gov

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