To request a non-clinical Medi-Cal service like housing navigation, medically tailored meals, or home modifications, you fill out your Medi-Cal Managed Care Plan’s CalAIM Community Supports referral form, document why the member qualifies, and send it to the plan’s Community Supports team through the channel the plan designates. Each plan designs its own version of the form, but the information collected is largely the same across plans.
Where to Get the Right Form
There is no single statewide form. Your Medi-Cal Managed Care Plan (MCP) publishes its own, usually on its provider portal, and often links to it from the CalAIM or Community Supports page of its public website. If you cannot find it, call the plan’s member services line and ask for the Community Supports referral form. Members, caregivers, and providers can all make that call.1Department of Health Care Services. Medi-Cal Community Supports Supplemental Fact Sheet
Not every plan offers every Community Support, and offerings vary by county. Before you start filling anything out, confirm the plan actually offers the service you need. The DHCS Medi-Cal Managed Care Health Plan Directory tells you which plan covers your county.2Department of Health Care Services. Medi-Cal Managed Care Health Plan Directory
Who Can Submit a Referral
You do not need a doctor’s order. DHCS requires managed care plans to accept referrals from members themselves, family members, guardians, caregivers, Enhanced Care Management providers, Community Supports providers, other healthcare providers, and community-based organizations.3Department of Health Care Services. Community Supports Policy Guide Volume 1 A shelter case manager, a member’s adult child, or the member sitting in a library can all initiate the same referral. CalOptima, for example, gives members the option to fill out and submit a Community Supports referral form on their own.4CalOptima Health. CalAIM If you are referring on someone else’s behalf, have their Medi-Cal information in front of you before you start.
What the Form Asks For
Partnership HealthPlan’s Community Supports Referral Form is a useful reference, because its layout tracks what most plans collect.5Partnership HealthPlan of California. Community Support Services Referral Form Expect three blocks of fields.
The Service You Are Requesting
Check the box for the specific Community Support. If the member needs more than one, you will typically submit a separate referral for each. Examples of what you might see on the checklist include Housing Transition Navigation Services, Housing Deposits, Transitional Rent, Recuperative Care, Medically Tailored Meals, Personal Care and Homemaker Services, Environmental Accessibility Adaptations, Sobering Centers, and Asthma Remediation. The full menu is set by DHCS and includes 15 services as of July 1, 2025, when Transitional Rent was added.1Department of Health Care Services. Medi-Cal Community Supports Supplemental Fact Sheet
Referrer and Member Identification
For the referrer: organization name, your name, phone, fax, email, and date. For the member: Client Identification Number (CIN), first and last name, address, county, and phone. The CIN is a nine-character alphanumeric code printed on the front of the Benefits Identification Card, and it needs to match exactly.6Sacramento County Department of Health Services. Recipient Eligibility Confirm the member’s current mailing address so any correspondence or delivered goods reach them.
Clinical and Social Justification
This is where referrals succeed or stall. The form has fields for diagnosis (a written description or ICD-10 code), emergency department visits, hospitalizations, mental or behavioral health conditions, physical health issues, and substance use history. Fill in every field that applies. A Housing Deposits referral that notes recent ED visits for untreated asthma and current shelter status paints a clearer picture than one that only checks a box.
If the form includes a free-text “Additional Information” section, use it. Describe the member’s current living situation, what has been tried before, and why this specific service would prevent a more expensive level of care such as a hospital stay or nursing facility placement. Attached medical records or social service assessments strengthen the request, though DHCS prohibits plans from requiring documentation beyond the referral standards for authorization.7Department of Health Care Services. Closed Loop Referral (CLR) FAQ
The plan will evaluate the member against the specific eligibility criteria for the service you selected, so the details you provide are what the reviewer uses to decide. Each DHCS-approved service has its own criteria, generally built around a real risk of hospitalization, nursing facility placement, or an emergency department visit without the requested support.3Department of Health Care Services. Community Supports Policy Guide Volume 1 One baseline applies across the board: the member must be enrolled in a Medi-Cal Managed Care Plan.8CalAIM. Community Supports
How to Submit the Form
Send the form through the channel your plan designates. Plans generally accept referrals through a secure provider portal, a dedicated fax line, or an encrypted email address. Some publish those details on their website; others print them on the referral form itself. Health Net, for example, accepts Community Supports referrals through its provider portal or by secure fax, while Blue Shield Promise uses encrypted email and SFTP.9L.A. Care Health Plan. LA County ECM Benefit – Adult Member Referral Form
Members self-referring may have a simpler online form or a phone option. CalOptima lets members submit a Community Supports referral through its website or by calling 1-888-587-8088.4CalOptima Health. CalAIM
Whichever route you use, confirm the plan received the submission. Request a tracking number or confirmation receipt so you have a reference point if you need to follow up. Make sure the form reaches the plan’s Community Supports team specifically, not its general medical authorization queue, because misrouted referrals get delayed.
What Happens After You Submit
The plan reviews the referral to decide whether the member meets eligibility for the requested service. Processing times vary by plan and service. Some plans process routine referrals within five business days when documentation is complete and turn urgent referrals around in as few as three business days.10Sacramento County Department of Health Services. CalAIM Community Supports by Managed Care Plans DHCS requires expedited authorization for time-sensitive services such as Recuperative Care, Short-Term Post-Hospitalization Housing, and Sobering Centers.3Department of Health Care Services. Community Supports Policy Guide Volume 1
If the plan needs more information, it will contact the referring party for additional notes or clarification. Once approved, the plan issues an authorization and connects the member with the community-based provider delivering the service, whether that is a housing agency, a meal vendor, or a home modification contractor. The member then coordinates directly with that provider.
Since July 1, 2025, DHCS requires plans to follow Closed-Loop Referral procedures, which track every referral from submission through service delivery and help prevent requests from stalling without follow-up.7Department of Health Care Services. Closed Loop Referral (CLR) FAQ
If the Plan Denies the Referral
Common reasons a plan declines a Community Supports referral include the provider lacking capacity, the member living outside the provider’s service area, or the plan determining the member does not meet eligibility criteria for that service.7Department of Health Care Services. Closed Loop Referral (CLR) FAQ
When a plan denies, reduces, or delays a service, that is an Adverse Benefit Determination, and the plan must send a written notice explaining why. The member has 60 calendar days from the date of that notice to file an appeal with the plan. The plan must acknowledge the appeal in writing within five days and resolve it within 30 days.
If the plan upholds the denial on appeal, the member can request a Medi-Cal state fair hearing through the California Department of Social Services. The deadline is 120 calendar days from the date of the plan’s appeal decision. A member already receiving a service that the plan wants to reduce or terminate can ask that the service continue during the appeal, known as aid paid pending, if the request is made before the effective date of the change.