Program Information Page 3
Non-Medical Out-of-Home Care (NMOHC) Payment
NMOHC is a payment supplement that boosts a person's monthly SSI check because they live in a licensed assisted living home rather than an apartment or house.
In California, if a person lives in a Residential Care Facility for the Elderly (RCFE), the state recognizes that costs are much higher than someone living independently. To help cover this, the person moves from the "Independent Living" rate to the "NMOHC" rate.
1. Confirm Financial Eligibility (The "Paper" Test)
Since NMOHC is part of the SSI program, you can verify the financial requirements now.
- Income: For 2026, total "countable" monthly income must be less than $1,626.07.
- Assets: As of January 1, 2026, asset limits are reinstated. An individual must have less than $2,000 in countable resources ($3,000 for a couple).
- Note: One car and the primary home are usually excluded from this limit.
2. Verification with Social Security (The "Pre-Move" Call)
Contact SSA at 1-800-772-1213 or visit a local office for a living arrangement interview.
- Tell them the person plans to move into a licensed RCFE.
- Ask for the new SSI payment calculation based on the 2026 NMOHC rate.
- Pro tip: Ask the RCFE for their License Number and a draft Admission Agreement. SSA will need a signed version to update the check.
"Room and Board" and "Assisted Living" Payments
The MCP member is responsible for paying the RCFE the 'room and board' portion and the MCP is responsible for paying the RCFE the 'assisted living' portion.
For members eligible for SSI/SSP and the 2026 Non-Medical Out of Home Care payment (NMOHC), SSI/SSP is bumped up to $1,626.07. The member usually retains $182 for personal needs expenses and the RCFE receives the $1,444.07 balance as payment for "room and board". Also, members eligible for the NMOHC will pay at least $1,447.00 to the RCFE. Members who receive more than this amount can pay more for 'room and board' for a private room or to open up RCFEs in more expensive areas.
Members not eligible for the NMOHC will still have a 'room and board' obligation but the amount could be flexible depending on the RCFE and the assessed tiered level.
Members who cannot pay any room and board portion usually are not eligible for the CS since program requirements mandate a 'room and board' payment from the member (or their family).
Working with CalAIM is at the discretion of the RCFEs. Many RCFEs, especially in more expensive areas, most likely will not participate in CalAIM. Families looking to place members in expensive real estate areas should have the realistic expectation that CalAIM RCFEs might only be located in more affordable areas.
Share of Cost (SOC)
A Share of Cost (SOC) is like a monthly deductible for Medi-Cal. It's the amount of money you may have to pay each month towards medical-related services or supplies before your Medi-Cal coverage begins to pay.
This happens when your income is above the limit for free Medi-Cal but you still qualify for the program.
Members cannot apply for CalAIM with a SOC. It must be eliminated before becoming eligible to apply for CalAIM.
Read more about eliminating share of cost at the California Advocates for Nursing Home Reform (CANHR).
Benefitscal.com
A one stop shop to apply and review Medi-Cal benefits including possible share of cost information and to add for the member an authorized representative/power of attorney.
Visit www.benefitscal.com for current SOC verification and more information.
Individual Service Plan (ISP)
An Individual Service Plan (ISP) is a comprehensive assessment conducted by the Managed Care Plan's (MCP) clinical team to determine the member's care needs and to approve them for the program. The ISP assessment is a critical step for getting the MCP's authorization. The ISP is either done virtually (Health Net) or in-person (Kaiser) by a Connections' MSW/RN to administer a tool to determine level of care (the amount the MCP will pay for the 'assisted living' portion). For Health Net, the tiered level is determined by Connections. For Kaiser, the tiered level is determined by Kaiser.
CalAIM Turnaround Time
For Health Net (5-7 business days):
- We compile all the required documents, have a RN do a virtual ISP visit with appropriate party.
- We determine the tiered rate.
- We recommend RCFEs to the family (in many cases, the family already knows the RCFE they would like for their relative).
- We submit the authorization request and receive the determination (approval or denial) within 5-7 business days.
For Kaiser (2-4 weeks):
- Compile required documents & Request Authorization.
- Receive authorization determination.
- If approved, send RN (or MSW with RN sign off) to do in-person visit with ISP tool.
- Send ISP tool to Kaiser for tier level.
- Receive tier level and recommend RCFEs to family.
- Once RCFE is selected sent RCFE to Kaiser for contracting and when RCFE receives Kaiser contract member can move into the RCFE.
Next Steps: The Application
The next section is for filling out the CS Summary Form. This is the core of your application.
Based on the selections you make in the summary form (like the pathway), a personalized list of other required documents will be generated for you to upload.