25-1386m 2026 CalAIM Program Updates: What Medi-Cal Providers Need to Know

Date: 12/22/25

Prepare for new CalAIM requirements—updated guides, forms and processes take effect January 1, 2026

Starting January 1, 2026, several Community Supports (CS) programs will have updated authorization guides, forms and processes. These changes impact authorizations and billing for services.

Why these changes are happening

The Department of Health Care Services is implementing these changes for CalAIM to comply with recent state legislation and policy requirements. The changes will:

• Align CS providers with updated state and federal standards.
• Improve program integrity and accountability through clearer documentation and standardized processes.
• Support cost containment and equitable access to services that address social drivers of health, such as housing supports, asthma preventive care and personal care services.

Action for providers

To ensure compliance with changes to the CS programs included in this communication, be sure to access the CalAIM Resources for Provider page on or after January 1, 2026 for the most current authorization guides and forms.

Key updates by program

Asthma Preventive Services (APS) and Asthma Remediation: removal of in-home environmental trigger assessments and asthma self-management education from the asthma remediation community support effective January 1, 2026

• APS includes asthma education and in-home environmental trigger assessments for eligible Medi-Cal members of any age, when medically necessary and recommended by a licensed practitioner. The Asthma Preventive Services Authorization Form will be used to request additional units.
• Asthma Remediation is available to eligible members with a completed in-home environmental trigger assessment within the last 12 months through the APS benefit that identifies medically appropriate asthma remediations and specifies how the interventions meet the needs of the member.

Housing Deposit: new coverage limits and documentation

• Security deposit coverage is now limited to one month’s rent (or two months for small landlords); first and last month’s rent are no longer covered.
• Lifetime maximum benefit remains $6,000.
• Providers must submit required documentation and follow strict timelines for approved items and services.

Housing Navigation and Tenancy: updated referral and eligibility

• Authorization form now includes housing support services, member eligibility, and required authorizations.
• Eligibility criteria now aligns with current program requirements.

Housing Tenancy and Sustaining Services: updated standards

• Updates applied to program overview, eligibility, authorization and restrictions in the authorization guide.
• Includes requirements for supporting members with maintaining a safe and stable tenancy. For housing transition navigation services, revised activities and qualifications.
• Updates cover activities, eligibility, documentation and provider qualifications.
• Sections revised to align with current requirements.

Personal Care and Homemaker Services (PCHS): changes to billing guidance

Key changes:

• Simplified eligibility guidelines.
• Billing now in 15-minute increments following the “Rule of Eights.”

Need help? Contact us

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral Health providers can call 844-966-0298.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.