Resources & FAQ

Yes — for eligible Medi-Cal Managed Care members, CalAIM Community Supports including PCHS and Respite are provided at no additional cost through your Managed Care Plan. There is no copay or cost-sharing requirement for these services.

Yes. PCHS is specifically designed to complement IHSS. You can receive PCHS during the IHSS application process, and once IHSS is approved, PCHS can supplement IHSS hours when the county-approved hours aren't enough to cover your full needs. The programs can run simultaneously.

Unfortunately, no. CalAIM Community Supports are only available to Medi-Cal members enrolled in a Managed Care Plan. Fee-for-service Medi-Cal members are not eligible. However, your county can help you transition to managed care enrollment, which would then open access to CalAIM benefits. Contact your county Medi-Cal office or call 1-800-541-5555.

Hours are determined by your Managed Care Plan based on a functional assessment of the member's needs. There is no statewide fixed hour limit, but plans have discretion in setting authorization amounts. If you believe the authorized hours are insufficient, you can request a reassessment or file a grievance with your plan.

Unlike IHSS (where members can hire their own provider), CalAIM PCHS is typically delivered through a contracted home care agency like Divine Agape. Family members generally cannot be paid as PCHS providers under CalAIM, but this may vary by plan. IHSS is the better option for members who want to hire a family member.

Enhanced Care Management (ECM) is a care coordination benefit for the highest-complexity Medi-Cal members. An ECM Lead Care Manager helps coordinate all of a member's medical and social services. Community Supports (like PCHS and Respite) are the actual services those members receive. ECM and Community Supports are often used together, but each can be authorized independently.

Call your plan's Member Services number (on the back of your Medi-Cal card) and ask specifically: "Does my plan offer Personal Care and Home Supports (PCHS) and Caregiver Respite in my county?" You can also check the DHCS Community Supports Elections document at dhcs.ca.gov for a county-by-county breakdown of which plans offer which supports.

You have the right to appeal. First, request a plan-level grievance or appeal through your MCP. If that is denied, you can request a State Hearing through the California Department of Social Services, or file a complaint with the Department of Managed Health Care (DMHC) at dmhc.ca.gov. Consider contacting a patient advocate or legal aid organization for support.

Respite is specifically designed to give the primary unpaid caregiver a break. While PCHS focuses on the member's personal care and daily living needs, Respite is authorized based on the caregiver's need for relief — not just the member's needs. Both require a TAR through the MCP, but the justification and focus of each are different.