More than one in 10 California nursing facility residents have low care needs and could potentially be well served in more residential, supportive settings like assisted living communities. Although assisted living has primarily operated as a private-pay residential model, eligible Medi-Cal enrollees can gain access to assisted living through some specialized pathways, which have the opportunity to grow under CalAIM (California Advancing and Innovating Medi-Cal).

This explainer aims to help Medi-Cal managed care plans (MCPs) and other stakeholders learn more about assisted living and its role for Medi-Cal enrollees, including through CalAIM. By expanding access to assisted living through Community Supports, MCPs can improve quality of life for their members, help alleviate discharge bottlenecks, and provide more cost-effective care solutions.

The two most common licensure categories are explained: residential care facilities for the elderly (RCFEs) and adult residential facilities (ARFs). RCFEs serve residents age 60 or older, while ARFs serve residents age 18 to 59. With 24/7 staffing, these settings deliver personal care — and at times, clinical services — to support adults in primarily non-medical residential environments and foster independence by addressing housing and functional needs, including Activities of Daily Living.