Community Supports (CS)

What is it?

Gold Coast Health Plan (GCHP) works with the Ventura County Health Care Agency to support the Asthma Remediation Program. This program helps members make changes to their home for their health, welfare, and safety and to prevent asthma flare-ups that could result in the need for visits to the Emergency Department (ED) and hospital stays.

The program can help with:

• Allergen-impermeable mattress and pillow dust covers.
• High-Efficiency Particulate Air (HEPA) filtered vacuums.
• Integrated Pest Management (IPM) services.
• De-humidifiers.
• Air filters.
• Minor mold removal.
• Ventilation Improvements.
• Asthma-friendly cleaning products and supplies.

Who is eligible?

Members who are eligible are those with poorly controlled asthma defined by:

• ED visits or hospital stays.
• Two sick or urgent care visits in the past 12 months.
• Score of 19 or lower on the Asthma Control Test.

To learn more, visit the Ventura County Health Care Agency or call them at 1.805.981.5183, Monday through Friday, 8 a.m. to 5 p.m. If you use a TTY, call 711. You can also email AsthmaRemediation@ventura.org.

What is it?

Provides for individuals who need assistance with Activities of Daily Living (ADLs) such as bathing, dressing, toileting, ambulation, or feeding. Caregiver Services can also include assistance with Instrumental Activities of Daily Living (IADLs), such as meal preparation, grocery shopping, and money management.

Who is eligible?

• Individuals at risk for hospitalization or institutionalization in a nursing facility; OR
• Individuals with functional deficits and no other adequate support system; OR
• Individuals approved for In-Home Supportive Services (IHSS). This cannot be used instead of, but may be used in addition to, IHSS. Members must be referred to the IHSS program when they meet referral criteria.

What is it?

Helps individuals to live in the community and avoid further institutionalization.

Who is eligible?

• Member is currently receiving medically necessary nursing facility Level of Care (LOC) services and instead of remaining in the nursing facility or Medical Respite setting, is choosing to transition home and continue to receive medically necessary nursing facility LOC services, AND
• Has lived 60+ days in a nursing home and/or Medical Respite setting, AND
• Is interested in moving back to the community, AND
• Is able to reside safely in the community with appropriate and cost-effective support and services.

What is it?

These are physical adaptations necessary to ensure the individual’s health, welfare, and safety or enable the individual to function with greater independence in the home, without which the member would require institutionalization.

Examples of environmental accessibility adaptions include:

• Ramps and grab-bars to assist members in accessing the home
• Doorway widening for members who require a wheelchair
• Stairlifts
• Making a bathroom and shower wheelchair accessible (e.g., constructing a roll-in shower)
• Installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies of the member, AND
• Installation and testing of a Personal Emergency Response System (PERS) for members who are alone for significant time and require routine supervision (including monthly service costs)

Who is eligible?

Individuals at risk for institutionalization in a nursing facility.

Restrictions/Limitations:

• Physical therapy and occupational assessments will be needed to determine the member’s needs
• If another State Plan service, such as Durable Medical Equipment (DME), would accomplish the same independence goals and avoid institutional placement, that service should be used
• EAAs must be conducted in accordance with applicable state and local building codes
• EAAs are payable up to a total lifetime maximum of $7,500. The only exceptions to the $7,500 maximum are:
  • If the member’s place of residence changes, OR
  • If the member’s condition has changed so significantly those additional modifications are necessary to ensure the member's health, welfare, and safety, or to enable the member to function with greater independence in the home and avoid institutionalization or hospitalization

What is it?

Funding for one-time services necessary to establish a household, including security deposits, first month’s utilities, equipment needed for a health condition, or first and last month’s rent.

Who is eligible?

Homeless / at risk of homelessness AND at least one of the following:

• One or more serious chronic condition
• Serious Mental Illness (SMI) / Substance Use Disorder (SUD)
• At risk of institutionalization
• Serious Emotional Disturbance (SED) (children / adolescents)
• Exiting incarceration, OR
• Transitional-aged youth with significant barriers to housing

*Must be receiving Housing Transition Navigation Services.

What is it?

Help with keeping housing, including help with managing money and good tenant behaviors.

Who is eligible?

Homeless / at risk of homelessness AND at least one of the following:

• One or more serious chronic condition
• Serious Mental Illness (SMI) / Substance Use Disorder (SUD)
• At risk of institutionalization
• Serious Emotional Disturbance (SED) (children / adolescents)
• Exiting incarceration, OR
• Transitional-aged youth with significant barriers to housing

What is it?

Help with finding and getting housing, including help with housing applications.

Who is eligible?

Homeless / at risk of homelessness AND at least one of the following:

• One or more serious chronic condition
• Serious Mental Illness (SMI) / Substance Use Disorder (SUD)
• At risk of institutionalization
• Serious Emotional Disturbance (SED) (children / adolescents)
• Exiting incarceration, OR
• Transitional-aged youth with significant barriers to housing

What is it?

Meals designed for specific medical needs.

Meal Provider Contacts

Bento
1.800.936.3022 / TTY 711 (8 a.m. to 6 p.m., 7 days a week)
www.gobento.com

Fresh & Fabulous
1.805.486.4547 / TTY 711 (8 a.m. to 5 p.m.)
https://www.myfreshandfabulous.com

The Medical Kitchen by Slate
1.805.586.9233 / TTY 711 (8 a.m. to 6 p.m.)
https://themedicalkitchen.com

Tangelo
1.866.291.9125 / TTY 711 (9 a.m. to 7 p.m.)
https://www.jointangelo.com/consumers

Water’s Edge
1.855.768.7436 / TTY 711 (8 a.m. to 5 p.m.)
https://www.nurifo.com

What is it?

Nursing Facility Transition / Diversion services assist individuals to live in the community and/or avoid institutionalization when possible.

Who is eligible?

For Nursing Facility Transition:

• Has resided 60+ days in a nursing facility, AND
• Willing to live in an assisted living setting instead of a Nursing Facility, AND
• Able to reside safely in an assisted living facility with appropriate and cost-effective support

For Nursing Facility Diversion:

• Currently receiving medically necessary nursing facility Level of Care (LOC), AND
• Willing and able to live safely in an assisted living facility with appropriate and cost-effective support and services, AND
• Must be receiving medically necessary nursing facility care or meet the minimum criteria to receive nursing facility services. Instead of going into a facility, members choose to remain in the community. They could receive needed services at an Assisted Living Facility.

What is it?

Short-term housing and medical care for members leaving the hospital who are likely to get worse without support.

Who is eligible?

Members who are at risk of being admitted or re-admitted into the hospital AND at least one of the following:

• Are homeless or at risk of homelessness
• Live alone with no formal supports
• Housing insecurity that puts their health and safety at risk

What is it?

Respite Services are provided to caregivers of members who require intermittent, temporary supervision. The services are offered short term because of the need for relief of the caregiver. This service is distinct from medical respite / recuperative care and is rest for the caregiver only.

Who is eligible?

Members who live in the community and are dependent on a qualified caregiver to provide most of their support, including Activities of Daily Living (ADLs), and who require caregiver relief to avoid institutional placement.

What is it?

Short-term housing and medical support for members leaving a hospital or treatment facility. This is a one-time service.

Who is eligible?

• Individuals who are homeless
• Individuals that are exiting recuperative care
• Individuals exiting an inpatient hospital stay (either acute or psychiatric or Chemical Dependency and Recovery hospital), residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, or nursing facility and who are receiving Enhanced Care Management (ECM) or who have one or more serious chronic conditions and/or serious mental illness and/or are at risk of institutionalization or requiring residential services as a result of a substance use disorder.