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Submit a Referral

For nurses, case managers, discharge planners, and families. Send a referral and a care coordinator responds within 1 business day. We handle the plan paperwork.

Illustration of a case manager handing off a patient referral to a home care coordinator

Referral form

Share what you can. We will follow up for anything missing.

Community partnership questions (chambers, schools, workforce programs) belong on our Community Partners page, not this referral form.

Referrals we accept

We provide non-medical home care across Ventura County and nearby Los Angeles County towns. We accept:

  • Medi-Cal Managed Care members referred under CalAIM Community Supports: PCHS and Caregiver Respite
  • Private-pay referrals from providers or directly from families

The process is the same for discharge planners, case managers, social workers, and families. Send us the basics and we take it from there. We handle the plan authorization paperwork. Every referral gets a response within 1 business day.

Referral form

The fastest route. Fill out the form at the top of this page with the client's needs and contact details. It takes about 5 minutes.

Phone

Call (805) 951-1121 and press 1 for Care Coordination. Monday to Friday, 9 AM to 5:30 PM.

Email

Send referral details to our intake address: psvintake@caregiving.divineagape.org.

What happens after you refer

1. We review

Illustration of a care coordinator with a headset reviewing a referral at her desk

A care coordinator reviews the referral. We respond within 1 business day to confirm details and next steps.

2. Free home assessment

Illustration of a care supervisor sitting on a sofa listening to an older man and his daughter

A care supervisor completes a free in-home functional assessment, usually within 2 to 5 days, and builds the care plan. The client and family can adjust the care plan at any time.

3. Plan approval

Illustration of an older woman and her daughter happily reading an approval letter together

For CalAIM referrals, we submit the authorization to the member's plan. Standard review takes 3 to 7 business days. Expedited review takes 24 to 72 hours.

Full process details: How CalAIM Works · Eligibility criteria: Do You Qualify?

What our services can do

A quick scope reference for referring providers.

PCHS covers

  • Personal care: bathing, dressing, grooming, toileting, mobility and transfers, feeding help
  • Homemaker help: meals, cleaning, laundry, grocery shopping
  • Medication reminders and accompaniment to medical appointments
  • Caregiver Respite: relief for the family caregiver, up to 336 hours per calendar year as the plan approves

Out of scope

  • Skilled nursing, wound care, injections, therapy
  • Administering medication (we remind and report only)
  • Anything requiring a licensed medical professional

We are a non-medical Home Care Organization (HCO #564700090).

Who fits the criteria

Medi-Cal managed care members who meet at least one (per the DHCS Community Supports policy):

  • At risk of hospitalization or nursing-facility placement, or
  • Functional deficits with no other adequate support, or
  • Approved for IHSS

IHSS stays primary. PCHS bridges the application or reassessment wait, supplements insufficient hours, or gives up to 60 days of help to members not eligible for IHSS.

Authorization status: what to expect

While it is pending

We complete the free in-home assessment during the review, so nothing waits on us. Standard review: 3 to 7 business days. Expedited: 24 to 72 hours. We keep the referrer and family posted.

When it is approved

The plan sets the hours. We confirm the schedule within 1 business day of approval, and the member meets their caregiver before the first visit.

If it is not approved

The member can appeal with the plan, ask the DMHC for an outside review, or request a State Hearing. Other paths: private pay from $45 an hour, or the IHSS route if they qualify. If the member's condition changes, a new referral can go in.

Urgent starts and retroactive authorization. Mark urgent referrals clearly, especially hospital discharges. Urgent cases get the expedited review. When waiting is not safe, care can begin before the written approval arrives, and the plan can authorize it back to the start date. We confirm every early start with the plan before the first visit, so the member is never billed for covered care.

Supporting documents that speed things up

Send what you have with the referral. We will chase the rest.

  • Member name and date of birth
  • Medi-Cal ID number (CIN)
  • Address, phone, and the main family contact
  • A short note on daily needs or the reason for referral
  • Guardian, POA, or conservator contact, if any
  • Discharge letter or after-visit summary
  • A doctor's letter, if there is one
  • Current care plan or diagnoses that affect daily activities
  • IHSS status: has it, applied, or denied
  • Any other supporting documents

Questions before you refer?

Call us Monday to Friday, 9 AM to 5:30 PM. We respond within 1 business day.

Call (805) 951-1121   Send a Referral

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