Publicly Funded Care Coordination & Transitional Support

Navigating publicly funded care programs can be complex and overwhelming—especially during times of medical change or care transitions. ElderPath Care Coordination and Transitional Support provides non-clinical guidance, education, and coordination to help individuals and families understand publicly funded care systems and navigate transitions with clarity and confidence.

We work alongside licensed providers, managed care plans, and community partners to support continuity of care while respecting individual choice and program requirements.

Our Role in Publicly Funded Care

ElderPath provides care coordination and transitional support, not benefit delivery.

Our role is to help individuals and families:

Understand Programs

Learn how publicly funded care programs work

Coordinate Services

Bridge providers and care settings

Navigate Transitions

Prepare for and support care transitions

Facilitate Communication

Connect with care teams and representatives

Important: ElderPath does not provide Medi-Cal benefits directly, does not determine eligibility, and does not bill Medi-Cal or managed care plans.

Programs We Help Individuals Understand

ElderPath provides education and coordination support for publicly funded care programs

Medi-Cal Care Navigation

Medi-Cal is California's Medicaid program, providing health coverage for eligible individuals, including seniors and adults with complex care needs.

ElderPath helps individuals and families:

  • Understand Medi-Cal-covered services related to care coordination and transitions
  • Navigate care transitions while enrolled in Medi-Cal
  • Coordinate with plan-approved and licensed providers
  • Understand limitations such as coverage exclusions and cost responsibilities

CalAIM Initiatives

CalAIM is a California initiative designed to improve health outcomes by coordinating care across medical, behavioral, and social services.

ElderPath supports individuals by:

  • Providing education about CalAIM initiatives
  • Helping families understand how care coordination fits within CalAIM goals
  • Coordinating transitions alongside plan-approved providers
  • Supporting communication between individuals, families, and care teams

Enhanced Care Management (ECM)

Enhanced Care Management is a Medi-Cal benefit for individuals with complex medical or social needs.

ElderPath's role includes:

  • Helping individuals and families understand what ECM is and how it works
  • Supporting communication with ECM providers and care teams
  • Coordinating transitional support in alignment with ECM care plans
  • Assisting families in understanding roles and expectations

Important: ElderPath does not provide ECM services directly and does not enroll individuals into ECM.

Community Supports

Community Supports are optional Medi-Cal services designed to address social drivers of health and support individuals in community-based settings.

ElderPath assists by:

  • Educating individuals and families about available Community Supports
  • Coordinating with plan-approved providers
  • Supporting transitions from institutional settings to community environments
  • Aligning care coordination with available supports

Assisted Living Waiver (ALW)

The Assisted Living Waiver allows eligible Medi-Cal beneficiaries who meet nursing-level-of-care criteria to receive care services in community-based residential settings instead of nursing facilities.

Important Clarifications:

  • Medi-Cal does not cover room and board
  • The ALW covers care services only
  • Enrollment is limited and county-based

ElderPath supports individuals and families by:

  • Explaining the ALW process and eligibility requirements
  • Coordinating required assessments and documentation
  • Supporting transitions into community-based care settings
  • Providing ongoing coordination alongside waiver service providers

Who This Page Is For

This page is designed for:

Medi-Cal Beneficiaries

Individuals enrolled in Medi-Cal and their families

Caregivers

Those navigating publicly funded care options

Transitioning Individuals

Moving from hospitals or skilled nursing facilities

Families

Exploring community-based care with public benefits

Individuals with Disabilities

Accessing publicly funded care programs and supports

Professionals

Seeking care coordination support for clients

Important Compliance Clarifications

ElderPath Care Coordination and Transitional Support:

  • Does not provide Medi-Cal benefits
  • Does not determine eligibility for public programs
  • Does not enroll individuals into Medi-Cal or CalAIM programs
  • Does not bill Medi-Cal or managed care plans
  • Does not act as a placement agency or referral broker

All care and housing decisions remain with the individual, family, and licensed providers.

Ready to Navigate Publicly Funded Care?

If you or a loved one are navigating a care transition while enrolled in or exploring publicly funded care programs, we invite you to contact ElderPath Care Coordination and Transitional Support to learn how we can help coordinate services and support your transition.

Publicly Funded Care Navigation Throughout Southern California

ElderPath Care Coordination and Transitional Support provides publicly funded care navigation and transitional support services to individuals and families throughout Southern California, including Rancho Cucamonga, the Inland Empire, Los Angeles County, and Orange County.

Publicly Funded Care Coordination

Medi-Cal Care Navigation

CalAIM Support Services

Enhanced Care Management

Assisted Living Waiver Support

Southern California