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CalAIM Community Supports: Promoting Independent Living Among Older Adults and People with Disabilities


Launched January 1, 2022, the California Advancing and Innovating Medi-Cal (CalAIM) initiative affords Medi-Cal managed care plans (MCPs) new opportunity to offer any of 14 Community Supports (referred to nationally as “In Lieu of” Services [ILOS]) that provide person-centered services to address a variety of social drivers of health. Several of these Community Supports offer MCPs flexibility to help older adults and people with disabilities remain in their homes, participate in their communities, and live independently in the setting of their choice. These six services include:
• Respite Services;
• Nursing Facility Transition/Diversion to Assisted Living Facilities;
• Community Transition Services/Nursing Facility Transition to a Home;
• Personal Care and Homemaker Services;
• Environmental Accessibility Adaptations (Home Modifications); and
• Medically Supportive Food / Meals / Medically Tailored Meals.


ATI Advisory (ATI) – with support from the California Health Care Foundation (CHCF) – provides an overview of, and evidence summary for, six Community Supports most relevant to supporting independent living for older adults and people with disabilities. ATI also provides a series of recommendations for consideration by the state of California and MCPs to support the successful adoption, and ongoing provision, of Community Supports to facilitate independent living.

These resources and recommendations are informed by interviews with MCPs in California as well as national health plans, and a review of existing literature, state reports, MCP publications, and federal and state regulations regarding ILOS. An accompanying Evidence Compendium provides a detailed, sortable collection of literature reviewed on each Community Support described in the report featuring analyses of the literatures’ benefits across cost, healthcare utilization (including institutionalization), quality of life, caregiver experience, functional status, and other areas.


ILOS offer significant opportunity and flexibility for MCPs to tailor services to best address the unique needs of older adults and people with disabilities being served by Medicaid (Medi-Cal in California). Through these six Community Supports, there is great potential to improve health, improve quality of life, and keep people living safely in the community. As CalAIM transforms the healthcare and social service delivery landscape across California in coming years, partnerships developed by MCPs and Community Supports providers will continue to strengthen state capacity to address not only medical needs, but also the nonmedical LTSS and social supports necessary for independent living. Other states across the country can look to California’s experience to explore opportunities to leverage ILOS more broadly to support these populations.

ATI also participated in an accompanying webinar to discuss the intersection of Community Supports with the CalAIM Institutional Long-Term Care Carve-In; watch the webinar below.

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