Medi-Cal Recuperative Care Referrals: A Step-by-Step Guide for Hospital Social Workers

Bright communal dining and living area in an Empowering Potential Housing recovery residence

Discharging a Medi-Cal member to the street, a vehicle, or an unstable shelter can undermine medical recovery and increase the risk of emergency department visits and readmission. Recuperative care: also called medical respite: is designed to address that gap.

Recuperative care is short-term residential care for a person experiencing or at risk of homelessness who needs time to recover from an injury, illness, or significant behavioral health condition. The member no longer needs hospitalization but cannot safely recover in an unstable living environment.

This guide explains how hospital social workers, discharge planners, and SUD program staff can make effective Medi-Cal recuperative care referrals in San Diego.

Important 2026 update: Many Medi-Cal managed care plans now use initial recuperative care authorizations of up to 30 days, followed by 30-day extensions. The July 2026 plan changes also require closer tracking of service limits and updated clinical justification. Always confirm the current process with the member’s health plan.

Step 1: Confirm That the Member Meets Basic Eligibility

A member generally must meet all of the following criteria:

  1. Active Medi-Cal enrollment and assignment to a participating managed care plan.
  2. Current homelessness or risk of homelessness.
  3. A medical or behavioral health condition requiring recovery time.
  4. Medical needs significant enough that the member could otherwise experience an emergency department visit, hospital admission, or institutional placement.
  5. The ability to safely participate in a communal recuperative care setting.

The member does not have to be discharged directly from a hospital. A referral may be appropriate after discharge from a skilled nursing facility, residential SUD treatment, jail, or another institution. A member may also qualify while living unsheltered, couch surfing, or facing imminent loss of housing.

The referral must explain why housing instability creates a clinical risk. “The member is homeless” is not enough by itself. Connect the housing situation to the expected outcome:

  • The member cannot store or manage medications safely.
  • The member requires rest and monitoring after an acute illness or injury.
  • Exposure, dehydration, or lack of wound care could worsen the condition.
  • A shelter environment could increase relapse risk or destabilize a serious behavioral health condition.
  • Without structured support, the member is likely to return to the emergency department.

Behavioral health conditions, including substance use disorder and co-occurring mental health needs, may be relevant. The documentation must still show a recovery need and a credible risk of deterioration without recuperative care.

Bedroom in an Empowering Potential Housing recovery residence

Step 2: Verify the Health Plan and Identify the Receiving Provider

Recuperative care is a CalAIM Community Support administered through Medi-Cal managed care plans. It is not automatically available through every plan or every provider.

Before sending a referral:

  • Verify active full-scope Medi-Cal coverage.
  • Confirm the member’s managed care plan.
  • Confirm that the plan offers recuperative care in the relevant county.
  • Identify a contracted or otherwise approved receiving provider.
  • Confirm bed availability and admission criteria.
  • Ask the plan who must submit the authorization request.

Empowering Potential Housing provides medical respite and recovery-oriented housing in San Diego and is a contracted recuperative care and short-term post-hospitalization provider with Molina and Kaiser, according to its recuperative care referral page.

For Molina referrals, the updated Molina Recuperative Care Pre-Screen Form requires the accepting provider to be identified, bed availability to be confirmed, and eligibility criteria to be addressed before submission.

Step 3: Assemble a Complete Clinical and Social Work Packet

A strong referral packet allows the health plan and receiving provider to make a timely decision. Send current information rather than relying on a diagnosis list alone.

Typical documentation includes:

  • Face sheet and Medi-Cal information
  • History and physical
  • Hospital or facility discharge summary
  • Current diagnoses and ICD-10 codes
  • Comprehensive medication list
  • Medication administration or self-management information
  • Recent progress notes
  • Psychiatric or behavioral health notes, when applicable
  • SUD treatment records, when relevant
  • Surgical notes, wound documentation, or treatment orders
  • Physical or occupational therapy evaluations, when applicable
  • Social work notes
  • Housing status and homelessness documentation
  • Functional status, including ADLs and mobility
  • Follow-up appointments and transportation needs
  • Primary care and behavioral health provider information
  • Infection control information, including TB and COVID testing when required
  • Oxygen, catheter, ostomy, diabetes, anticoagulation, or other care needs
  • A post-discharge treatment and housing plan
  • Member consent or authorized representative information

The provider statement should be specific. For example:

“The member is recovering from [condition] and is experiencing homelessness. Without a safe recovery setting, medication storage, daily wellness monitoring, and connection to follow-up care, the member is at significant risk of worsening symptoms, relapse, emergency department utilization, or hospital readmission.”

Avoid unsupported statements such as “needs placement” or “homeless and appropriate.” The authorization reviewer needs to understand the medical necessity, the housing risk, and the expected benefit of recuperative care.

Step 4: Submit the Referral Before Admission

A recuperative care referral should be submitted to the health plan before the member enters the program. Retroactive authorization is not guaranteed.

The exact workflow varies by plan:

  • Some plans require the hospital to submit the request.
  • Some prefer the medical provider, ECM provider, or receiving facility to submit it.
  • Some require submission through a utilization management fax or portal.
  • Some require the provider’s NPI and direct contact information.

For referrals to Empowering Potential Housing:

  1. Fax the clinical packet to 619-333-1670.
  2. For Molina members, complete the Molina form and list Empowering Potential Housing as the accepting provider. EPH’s NPI is 1639985393.
  3. Confirm the health plan’s utilization management submission requirements. The Molina form identifies 833-305-3130 for completed forms and supporting documentation.
  4. Ask the member to complete a telephone screening with EPH at 619-500-3987.
  5. Coordinate transportation, medications, equipment, and arrival timing.

Use a secure fax or approved health information exchange. Do not send protected health information through unsecured personal email or text messaging.

Step 5: Plan for the 30-Day Authorization and Reauthorization

Effective July 22, 2026, Health Net’s provider notice states that initial recuperative care authorizations may be issued for up to 30 days, with extensions in additional 30-day increments. Molina’s updated form similarly states that recuperative care is authorized in 30-day increments.

This structure does not mean every member automatically receives 30 days. The plan may authorize fewer days based on medical necessity, the member’s recovery plan, or available documentation.

For every extension request:

  • Submit the request before the current authorization expires.
  • Provide updated clinical justification.
  • Describe progress toward medical stability and housing.
  • Document ongoing wellness monitoring and care coordination.
  • Include changes in diagnoses, medications, appointments, or functional status.
  • Explain why discharge is not yet safe or appropriate.
  • Identify the next housing or treatment step.

Molina’s form states that continuation requests should include updated justification and be submitted within seven calendar days of the current authorization end date. Do not wait until the final day. Build a reauthorization calendar at admission.

The National Health Care for the Homeless Council’s California recuperative care guide also emphasizes timely authorization, eligibility verification, care documentation, and coordination between providers and managed care plans.

Step 6: Track the Rolling Service Cap

Under the 2026 operational framework used by plans, the member may be subject to a combined 182-day limit in a rolling 12-month period for room-and-board Community Supports. Depending on the applicable plan rules and service dates, the cap may include:

  • Recuperative care
  • Short-Term Post-Hospitalization Housing
  • Transitional Rent

The rolling period generally begins with the member’s first date of service utilization, not simply the authorization date. Ask the health plan to verify:

  • The number of days already used
  • The date of the first applicable service
  • Whether other housing-related Community Supports count toward the member’s remaining balance
  • How the plan will apply the cap during transitions between services

Do not assume that an unused authorization equals used days. Confirm actual utilization with the plan.

DHCS released proposed July 2026 updates that would revise recuperative care after the current CalAIM demonstration period. The proposal retains a six-month maximum for recuperative care but changes how room and board is treated and describes the sunset of STPHH as a separate Community Support. Because implementation details may change, providers should follow the member’s current MCP guidance and obtain written clarification when necessary.

Step 7: Start the Long-Term Housing Plan at Admission

Recuperative care is a stepping stone, not a permanent housing solution. Discharge planning should begin when the member arrives.

Coordinate early with:

  • Enhanced Care Management
  • SUD treatment and mental health providers
  • Primary care
  • Housing Transition Navigation Services
  • Housing Tenancy and Sustaining Services
  • County behavioral health
  • Permanent supportive housing programs
  • Recovery residences
  • Benefits and entitlement navigators
  • Family or other approved supports

A good medical respite program does more than provide a bed. It creates accountability around appointments, medication routines, recovery goals, and housing preparation.

Residents participating in peer support and community connection

At Empowering Potential Housing, medical respite includes daily wellness checks, clinical oversight, care planning, healthy meals, transportation coordination, and linkage to treatment and housing resources. When appropriate, members may transition into an EPH recovery residence. These homes provide a structured, drug- and alcohol-free environment with peer accountability, recovery support, utilities, and high-speed internet. Residents may follow AA, NA, SMART Recovery, Refuge Recovery, Celebrate Recovery, or another appropriate recovery pathway.

Common Referral Mistakes to Avoid

Sending a vague medical necessity statement

Explain the condition, the recovery need, and the risk of ED use or readmission without placement.

Omitting the housing details

Document whether the member is unsheltered, staying in a vehicle, exiting an institution, couch surfing, or facing loss of housing within the applicable timeframe.

Referring before confirming a provider and bed

Molina specifically requires an accepting provider and bed availability to be identified. Confirm placement before submitting the request.

Ignoring functional and safety requirements

A member must be able to participate safely in the setting. Identify ADL limitations, psychiatric instability, active communicable disease, central lines, complex wound care, oxygen needs, and medication assistance requirements.

Waiting too long to request an extension

Thirty-day authorizations require active tracking. Submit reauthorization materials early and include updated documentation.

Failing to check the rolling cap

Ask about prior recuperative care, STPHH, and Transitional Rent utilization. A member may have used days through another provider or county.

Discharging without a next step

A discharge to the street after a short authorization is not a successful transition. Arrange treatment, housing navigation, recovery housing, or another safe placement before the authorization ends.

A Reliable San Diego Referral Partner

Empowering Potential Housing helps hospitals, discharge planners, SUD programs, and health plans coordinate safe transitions for Medi-Cal members experiencing homelessness. To discuss a referral, confirm current bed availability, or arrange a screening:

When a member needs a safe place to heal, the right referral connects medical recovery with accountability, treatment, and a realistic path toward lasting housing stability.