Eligibility

Children and youth enrolled in Medi-Cal may be eligible for Activity Stipends if they:

• Are under age 21 and are currently involved in the child welfare system in California (As defined in BHIN 21-073, “involvement in child welfare” means the beneficiary has an open child welfare services case, or the beneficiary is determined by a child welfare services agency to be at imminent risk of entering foster care
  but able to safely remain in their home or kinship placement with the provision of services under a prevention plan, or the beneficiary is a child whose adoption or guardianship occurred through the child welfare system. A child has an open child welfare services case if: a) the child is in foster care or in out of home care, including both court-ordered and by voluntary agreement; or b) the child has a family maintenance case (pre-placement or post-reunification), including both court ordered and by voluntary agreement. A child can have involvement in child welfare whether the child remains in the home or is placed out of the home.)
• Are under age 21 and previously received care through the child welfare system in California or another state within the past 12 months;
• Have aged out of the child welfare system up to age 26 (having been in foster care on their 18th birthday or later) in California or another state;
• Are under age 18 and are eligible for and/or in California’s Adoption Assistance Program;
• Are under age 18 and are currently receiving or have received services from California’s Family Maintenance program within the past 12 months.

(BH CONNNECT CMS Application p. 23)

Eligibility

All youth will be eligible for Specialty Mental Health Services per CalAIM definition of “Involvement in child welfare” criteria: The beneficiary has an open child welfare services case, or the beneficiary is determined by a child welfare services agency to be at imminent risk of entering foster care but able to safely remain in their home or kinship placement with the provision of services under a prevention plan, or the beneficiary is a child whose adoption or guardianship occurred through the child welfare system. A child has an open child welfare services case if: a) the child is in foster care or in out of home care, including both court-ordered and by voluntary agreement; or b) the child has a family maintenance case (pre-placement or post-reunification), including both court ordered and by voluntary agreement. A child can have involvement in child welfare whether the child remains in the home or is placed out of the home. BHIN 21-073

Eligibility

For pre-placement activities, the federal definition of a candidate for foster care is a child at “imminent” or “serious”
risk of removal when placement in foster care is the planned arrangement

The determination made using 3 methods:

1. case plan documenting that absent preventive services foster care is the planned action (preferred method
   in CA
2. evidence of court proceedings
3. eligibility determination form

ACL 14-36

Eligibility

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service. Additionally, the individual must meet at least one of the following criteria:

Children and youth who are transitioning from a youth correctional facility or transitioned from being in a youth correctional facility within the past 12 months.

or Adults who:

1. Are transitioning from a correctional facility (e.g., prison, jail, or youth correctional facility) or transitioned from correctional facility within the past 12 months;
   AND
2. Have at least one of the following conditions (See Appendix C for definitions):
3. • (i) Mental illness;
   • (ii) SUD;
   • (iii) Chronic Condition/Significant Non-Chronic Clinical Condition; (iv) Intellectual or Developmental Disability (I/DD);
   • (v) Traumatic Brain Injury (TBI);
   • (vi) HIV/AIDS;
   • (vii) Pregnant or Postpartum.

(Enhanced Care Management Policy Guide, Sept 2023 pg. 33).

Eligibility

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service. Additionally, the individual must meet at least one of the following criteria:

Adults At Risk for Avoidable Hospital or ED Utilization

Adults who meet one or more of the following conditions:

1. (Five or more emergency room visits in a six-month period that could have been avoided with appropriate outpatient care or improved treatment adherence;
2. Three or more unplanned hospital and/or short-term skilled nursing facility (SNF) stays in a six-month period that could have been avoided with appropriate outpatient care or improved treatment adherence.

Children and Youth At Risk for Avoidable Hospital or ED Utilization

Children and youth who meet one or more of the following conditions:

1. Three or more ED visits in a 12-month period that could have been avoided with appropriate outpatient care or improved treatment adherence;
2. Two or more unplanned hospital and/or short-term SNF stays in a 12-month period that could have been avoided with appropriate outpatient care or improved treatment adherence. ECM Policy Guide Pg 18

Eligibility

Birth Equity Population of Focus (Adults and Youth)

Adults and youth who:

1. (Are pregnant OR are postpartum (through 12 months period);
   AND
2. Are subject to racial and ethnic disparities as defined by California public health data on maternal morbidity and mortality.

ECM Policy Guide pg. 54

The “postpartum” period is defined as the 12 month period following the last day of the pregnancy (irrespective of whether live or still birth delivery, or spontaneous or therapeutic abortion).

Clause 2 above is based on the California Department of Public Health’s (CDPH) most recent State public health data available on the Women/Maternal Dashboard Home Page (including the Pregnancy Related Mortality, Selected Maternal Complications, and Severe Maternal Morbidity Dashboards). ECM Policy Guide pg 53

No further criteria are required to be met to qualify for this ECM Population of Focus. MCPs may not impose additional eligibility requirements for authorization.

Eligibility

Children (Members under age 21) and their parent(s)/caregivers(s) well-child visits when delivered according to the Bright Futures/American Academy of Pediatrics periodicity schedule for behavioral/social/emotional screening assessment, and when medically necessary, in accordance EPSDT standards. Under EPSDT standards, a diagnosis is not required to qualify for services. DBH well-child visits are intended to be universal per the Bright Futures periodicity schedule for behavioral/social/emotional screening assessment. The DBH well-child visits do not need a particular recommendation or referral and must be offered as an appropriate service option even if the Member does not request them. The family is eligible to receive Dyadic Services so long as the child is enrolled in Medi-Cal. The parent(s) or caregiver(s) does not need to be enrolled in Medi- Cal or have other coverage so long as the care is for the direct benefit of the child.(APL 22-029 Revised March 20, 2023).

Eligibility

At least six months of post-discharge aftercare services must be provided to children discharged from a placement in an STRTP or from an out-of-state residential facility to a family-based setting.

WIC section 4096.6 also specifies that Federal Financial Participation (FFP) under the Medi-Cal program may be available if all state and federal requirements are met and the treatment is medically necessary, regardless of the six months post-discharge requirement. (BHIN 21-061)

Eligibility

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service.

Victims of domestic violence or trafficking technically qualify for ECM through the homelessness criterion (vii) Fleeing domestic violence, dating violence, sexual assault, stalking, and other dangerous, traumatic, or life-threatening conditions relating to such violence. (ECM Policy Guide pg.12)

Eligibility

Children and youth who meet one or more of the following conditions:

1. Are under age 21 and are currently receiving foster care in California;
2. Are under age 21 and previously received foster care in California or another state within the last 12 months;
3. Have aged out of foster care up to age 26 (having been in foster care on their 18th birthday or later) in California or another state;
4. Are under age 18 and are eligible for and/or in California’s Adoption Assistance Program;
5. Are under age 18 and are currently receiving or have received services from California’s Family Maintenance program within the last 12 months.

(Enhanced Care Management Policy Guide September 2023, pg. 48)

Eligibility

Child Welfare: All children and youth in foster care or the juvenile justice system or who are at risk of out-of-home care. WIC § 18251

Medi-Cal (MHP): Eligible for Specialty Mental Health Services and meet medical necessity for Medi-Cal Wraparound services billed individually, e.g., Intensive Care Coordination, peer support services, etc.

Wraparound payments can be used to pay for services, care and supervision, or both. Pursuant to W&IC Section 18254(c), any unspent Wraparound funds not used for a specific child’s placement and/or services costs must be put into the county
Wraparound Trust Fund account. These funds can then be used to provide Wraparound services to any other child with unmet needs. This includes children who are in out-of-home placement, at risk of removal, or who have been returned home and reunified with their family. It also includes children transitioning from a Short-Term Residential Therapeutic Program (STRTP)/GH to a less restrictive home-based placement. Counties should note any savings in the Wraparound Trust Fund must be reinvested as outlined above or in other child welfare programs.

A child/nonminor dependent at home is/or remains at imminent risk of removal but has not been removed from their home is not in foster care and won’t have an assigned aid code in MEDs for Medi-Cal billing. Because the child is not in foster care, they are not yet Medi-Cal eligible through the foster care program. The claiming is handled differently for this case. The Wraparound rate for services provided to this child/nonminor dependent are limited to the STRTP rate and are to be claimed on the County Expense Claim (CEC), using the appropriate PINs identified in the table on page five of CFL 20-21-94 .The PINs clarify these expenditures (up to but no more than the STRTP rate) are reimbursed through the county Wraparound Trust Fund/local sources of revenue.

***Update this after DHCS releases policy guidance on High Fidelity Wraparound (HFW) as a Medi-Cal benefit.

Eligibility

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service.

Children, Youth, and Families with members under 21 years of age who:

1. Are experiencing homelessness, defined as meeting one or more of the following conditions:
   • Lacking a fixed, regular, and adequate nighttime residence;
   • Having a primary residence that is a public or private place not designed
     for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground;
   • Living in a supervised publicly or privately operated shelter, designed to provide temporary living arrangements (including hotels and motels paid for by federal, state, or local government programs for low income individuals or by charitable organizations, congregate shelters, and transitional housing);
   • Exiting an institution into homelessness (regardless of length of stay in the institution);
   • Will imminently lose housing in next 30 days;
   • Fleeing domestic violence, dating violence, sexual assault, stalking, and other dangerous, traumatic, or life-threatening conditions relating to such violence; OR (2)
2. Sharing the housing of other persons (i.e., couch surfing) due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; or abandoned in hospitals (in hospital without a safe place to be discharged to), as modified from the 45 CFR 11434a McKinney-Vento Homeless Assistance Act definition of “at risk of homelessness” (Enhanced Care Management Policy Guide, Sept 2023 pg. 13).

Eligibility

In addition to meeting Specialty Mental Health Services (SMHS) criteria, these criteria are not requirements or conditions, but are provided as guidance, in order to assist counties in identifying children and youth who are in need of ICC and IHBS.

ICC and IHBS are very likely to be medically necessary for children and youth who:

• Are receiving, or being considered for, Wraparound;
• Are receiving, or being considered for, a specialized care rate due to behavioral health needs;
• Are being considered for other intensive SMHS, including, but not limited to, TBS, or are receiving crisis stabilization/intervention services;
• Are currently in, or being considered for, high-level-care institutional settings, such as group homes or Short-Term Residential Therapeutic Programs (STRTPs);
• Have been discharged within 90 days from, or currently reside in, or are being considered for placement in, a psychiatric hospital or 24-hour mental health treatment facility [e.g. psychiatric inpatient hospital, psychiatric health facility (PHF), community treatment facility, etc.];
• Have experienced two or more mental health hospitalizations in the last 12 months;
• Have experienced two or more placement changes, within 24 months, due to behavioral health needs;
• Have been treated with two or more antipsychotic medications, at the same time, over a three-month period;
• If the child is zero through five years old and has more than one psychotropic medication, the child is six through 11 years old and has more than two psychotropic medications, or the child is 12 through 17 years old and has more than three psychotropic medications;
• If the child is zero through five years old and has more than one mental health diagnosis, the child is six through 11 years old and has more than two mental health diagnoses, or the child is 12 through 17 years old and has more than three mental health diagnoses;
• Have two or more emergency room visits in the last 6 months due to primary mental health condition or need, including, but not limited to, involuntary treatment under California Welfare and Institutions (W &I) Code section 5585.50;
• Have been detained, pursuant to W&I sections 601 and 602, primarily due to mental health needs; or
• Have received SMHS within the last year, and have been reported homeless within the prior six months.

ICC is intended to link beneficiaries to services provided by other child-serving systems; to facilitate teaming; and to coordinate mental health care.

If a beneficiary is involved with two or more child-serving systems, the child should be getting ICC, and the Mental Health Plan should utilize ICC to facilitate cross- system communication and planning. (Medi-Cal Manual for Intensive Care Coordination (ICC), Intensive Home Based Services (IHBS), and Therapeutic Foster Care (TFC) Services for Medi-Cal Beneficiaries. Third Edition. January 2018.)

Eligibility

Adults who:

(1) Meet the eligibility criteria for participation in, or obtaining services through:

(i) SMHS delivered by MHPs;

(ii) The Drug Medi-Cal Organization Delivery System (DMC-ODS) OR the Drug Medi- Cal (DMC) program

AND

(2) Are experiencing at least one complex social factor influencing their health (e.g., lack of access to food, lack of access to stable housing, inability to work or engage in the community, high measure (four or more) of ACEs based on screening, former foster youth, history of recent contacts with law enforcement related to mental health and/or substance use symptoms;

AND

(3) Meet one or more of the following criteria:

(i) Are at high risk for institutionalization, overdose, and/or suicide;

(ii) Use crisis services, EDs, urgent care, or inpatient stays as the primary19 source of care;

(iii) experienced two or more ED visits or two or more hospitalizations due to serious mental health or SUD in the past 12 months;

(iv) are pregnant or postpartum (12 months from delivery).

*For children and youth:

Children and youth who:

(1) Meet the eligibility criteria for participation in, or obtaining services through one or more of:

(i) SMHS delivered by MHPs;

(ii) The DMC-ODS OR the DMC program.

(Enhanced Care Management Policy Guide September 2023, pg. 24)

Eligibility

Eligibility isn’t defined in the BH-CONNECT application; MCP criteria are below:

CHW services are considered medically necessary for Members with one or more chronic health conditions (including behavioral health) or exposure to violence and trauma, who are at risk for a chronic health condition or environmental health exposure, who face barriers in meeting their health or health-related social needs, and/or who would benefit from preventive services. The recommending Provider must determine whether a Member meets eligibility criteria for CHW services based on the presence of one or more of the following:

• Diagnosis of one or more chronic health (including behavioral health) conditions, or a suspected mental disorder or substance use disorder that has not yet been diagnosed.
• Presence of medical indicators of rising risk of chronic disease (e.g., elevated blood pressure, elevated blood glucose levels, elevated blood lead levels or childhood lead exposure, etc.) that indicate risk but do not yet warrant diagnosis of a chronic condition.
• Any stressful life event presented via the Adverse Childhood Events screening.
• Presence of known risk factors, including domestic or intimate partner violence, tobacco use, excessive alcohol use, and/or drug misuse.
• Results of a SDOH screening indicating unmet health-related social needs, such as housing or food insecurity.
• One or more visits to a hospital emergency department within the previous six months.
•  One or more hospital inpatient stays, including stays at a psychiatric facility, within the previous six months, or being at risk of institutionalization.
• One or more stays at a detox facility within the previous year.
• Two or more missed medical appointments within the previous six months.
• Member expressed need for support in health system navigation or resource coordination services.
• Need for recommended preventive services, including updated immunizations, annual dental visit, and well childcare visits for children.

CHW violence prevention services are available to Members who meet any of the following circumstances as determined by a licensed practitioner:

• The Member has been violently injured as a result of community violence.
• The Member is at significant risk of experiencing violent injury as a result of community violence.
• The Member has experienced chronic exposure to community violence.

Services may be provided to a parent or legal guardian of a member under age 21 for the direct benefit of the Member, in accordance with a recommendation from a licensed Provider. A service for the direct benefit of the Member must be billed under the Member’s Medi-Cal ID. If the parent or legal guardian of the Member is not enrolled in Medi-Cal, the Member must be present during the session. (APL 24-006)

Eligibility

County-Based Medi-Cal Administrative Activities (CMAA) became a Medi-Cal program on January 1, 1995, pursuant to (W&I) Code §14132.47. Local Governmental Agencies (LGAs) participating in the C​​​​MAA program are eligible to receive federal reimbursement for the cost of performing administrative activities that directly support efforts to identify and enroll potential eligible individuals into Medi-Cal. This can include contracted providers. (DHCS Time Survey Methodology for the County-Based Medi-Cal Administrative Activities and Targeted Case Management Programs and County-Based Medi-Cal Administrative Activities Program Operational Plan 7/1/2017).

Eligibility

CHW services are considered medically necessary for Members with one or more chronic health conditions (including behavioral health) or exposure to violence and trauma, who are at risk for a chronic health condition or environmental health exposure, who face barriers in meeting their health or health-related social needs, and/or who would benefit from preventive services. The recommending Provider must determine whether a Member meets eligibility criteria for CHW services based on the presence of one or more of the following:

• Diagnosis of one or more chronic health (including behavioral health) conditions, or a suspected mental disorder or substance use disorder that has not yet been diagnosed.
• Presence of medical indicators of rising risk of chronic disease (e.g., elevated blood pressure, elevated blood glucose levels, elevated blood lead levels or childhood lead exposure, etc.) that indicate risk but do not yet warrant diagnosis of a chronic condition.
• Any stressful life event presented via the Adverse Childhood Events screening.
• Presence of known risk factors, including domestic or intimate partner violence, tobacco use, excessive alcohol use, and/or drug misuse.
• Results of a SDOH screening indicating unmet health-related social needs, such as housing or food insecurity.
• One or more visits to a hospital emergency department within the previous six months.
• One or more hospital inpatient stays, including stays at a psychiatric facility, within the previous six months, or being at risk of institutionalization.
• One or more stays at a detox facility within the previous year.
• Two or more missed medical appointments within the previous six months.
• Member expressed need for support in health system navigation or resource coordination services.
• Need for recommended preventive services, including updated immunizations, annual dental visit, and well childcare visits for children.

CHW violence prevention services are available to Members who meet any of the following circumstances as determined by a licensed practitioner:

• The Member has been violently injured as a result of community violence.
• The Member is at significant risk of experiencing violent injury as a result of community violence.
• The Member has experienced chronic exposure to community violence.

Services may be provided to a parent or legal guardian of a Member under age 21 for the direct benefit of the Member, in accordance with a recommendation from a licensed Provider. A service for the direct benefit of the Member must be billed under the Member’s Medi-Cal ID. If the parent or legal guardian of the Member is not enrolled in Medi-Cal, the Member must be present during the session. (APL 24-006)

Eligibility

California’s State Plan lists 10 potential categories of circumstances under which children are eligible for prevention services through Title IV-E  provided that have also received an individual determination of “imminent risk” by the IV-E agency or Tribe with a IV-E agreement with the state.  California’s Five-Year State Prevention Plan (CDSS, 2023) p.23

Eligibility

Individuals with poorly controlled asthma (as determined by an emergency department visit or hospitalization or two sick or urgent care visits in the past 12 months or a score of 19 or lower on the Asthma Control Test) for whom a licensed health care provider has documented that the service will likely avoid asthma-related hospitalizations, emergency department visits, or other high-cost services.

DHCS Community Supports Policy Guide p.59

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service.

Eligibility

• Individuals who are prioritized for a permanent supportive housing unit or rental subsidy resource through the local homeless Coordinated Entry System or similar system designed to use information to identify highly vulnerable individuals with disabilities and/or one or more serious chronic conditions and/or serious mental illness, institutionalization or requiring residential services because of a substance use disorder and/or is exiting incarceration; or
• Individuals who meet the Housing and Urban Development (HUD) definition of homeless as defined in Section 91.5 of Title 24 of the Code of Federal Regulations (including those exiting institutions but not including any limits on the number of days in the institution) and who are receiving enhanced care management, or who have one or more serious chronic conditions and/or serious mental illness and/or is at risk of institutionalization or requiring residential services as a result of a substance use disorder. For this service, qualifying institutions include hospitals, correctional facilities, mental health residential treatment facilities, substance use disorder residential treatment facilities, recovery residences, Institutions for Mental Disease, and State Hospitals; or
• Individuals who meet the HUD definition of at risk of homelessness as defined in Section 91.5 of Title 24 of the Code of Federal Regulations as:
  • (1) An individual or family who:
    • Has an annual income below 30 percent of median family income for the
      area, as determined by HUD;
    • Does not have sufficient resources or support networks, e.g., family, friends, faith-based or other social networks, immediately available to prevent them from moving to an emergency shelter or another place described in paragraph (1) of the “Homeless” definition in this section; and
• Meets one of the following conditions:
  • Has moved because of economic reasons two or more times during the 60 days immediately preceding the application for homelessness prevention assistance;
  • Is living in the home of another because of economic hardship;
  • Has been notified in writing that their right to occupy their current housing or living situation will be terminated within 21 days after the date of application for assistance;
• Lives in a hotel or motel and the cost of the hotel or motel stay is not paid by charitable organizations or by federal, state, or local government programs for low-income individuals;
• Lives in a single-room occupancy or efficiency apartment unit in which there reside more than two persons or lives in a larger housing unit in which there reside more than 1.5 people per room, as defined by the U.S. Census Bureau;
• Is exiting a publicly funded institution, or system of care (such as a health-care facility, a mental health facility, foster care or other youth facility, or correction program or institution); or
• Otherwise lives in housing that has characteristics associated with instability and an increased risk of homelessness, as identified in the recipient’s approved consolidated plan;
  • (2) A child or youth who does not qualify as “homeless” under this section, but qualifies as “homeless” under section 387(3) of the Runaway and Homeless Youth Act (42 U.S.C. 5732a(3)), section 637(11) of the Head Start Act (42 U.S.C. 9832(11)), section 41403(6) of the Violence Against Women Act of 1994 (42 U.S.C. 14043e-2(6)), section 330(h)(5)(A) of the Public Health Service Act (42 U.S.C. 254b(h)(5)(A)), section 3(m) of the Food and Nutrition Act of 2008 (7 U.S.C. 2012(m)), or section 17(b)(15) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(b)(15)); or
  • (3) A child or youth who does not qualify as “homeless” under this section but qualifies as “homeless” under section 725(2) of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a(2)), and the parent(s) or guardian(s) of that child or youth if living with her or him.
    Individuals who are determined to be at risk of experiencing homelessness are eligible to receive Housing Transition Navigation services if they have significant barriers to housing stability and meet at least one of the following:
  • Have one or more serious chronic conditions;
  • Have a Serious Mental Illness;
  • Are at risk of institutionalization or overdose or are requiring residential services because of a substance use disorder or have a Serious Emotional Disturbance (children and adolescents);
  • Are receiving Enhanced Care Management; or
  • Are a Transition-Age Youth with significant barriers to housing stability, such as one or more convictions, a history of foster care, involvement with the juvenile justice or criminal justice system, and/or have a serious mental illness and/or a child or adolescent with serious emotional disturbance and/or who have been victims of trafficking or domestic violence. DHCS Community Supports Policy Guide p.14).

Eligibility

Medi-Cal members who are enrolled or eligible to enroll in Medi-Cal and whose County of Responsibility opts in to provide the services, meet access criteria for SMHS, are aged 18 years or older or are an emancipated minor, and who are experiencing or at risk of experiencing extended Length of Stays (120 days or more) in inpatient, residential, or subacute settings (including Institutions for Mental Disease or IMDs) will qualify for Community Transition In-Reach Services (BH CONNECT CMS Application Addendum)

Eligibility

Medi-Cal members may be eligible for up to 6 months of transitional rent services
through the BH-CONNECT demonstration in participating counties if they:

• Meet the access criteria for SMHS, DMC and/or DMC-ODS services; and
• Meet the US Department of Housing and Urban Development’s (HUD’s) current
  definition of homeless or the definition of individuals who are at risk of
  homelessness as codified at 24 CFR part 91.5, with two modifications:
  • If exiting an institution or a state prison, county jail, or youth correctional
    facility, individuals are considered homeless if they were homeless
    immediately prior to entering that institutional or carceral stay or become
    homeless during that stay, regardless of the length of the
    institutionalization or incarceration; and
  • The timeframe for an individual or family who will imminently lose housing
    is extended from fourteen (14) days for individuals considered homeless
    and 21 days for individuals considered at risk of homelessness under the
    current HUD definition to thirty (30) days; and
• Meet at least one of the following:
  • Are transitioning out of an institutional care or congregate residential
    setting, including but not limited to an inpatient hospital stay, an inpatient
    or residential substance use disorder treatment or recovery facility, an
    inpatient or residential mental health treatment facility, or nursing facility;
  • Are transitioning out of a state prison, county jail, or youth correctional
    facility;
  • Are transitioning out of the child welfare system;
  • Are transitioning out of a recuperative care facility or short-term posthospitalization
    housing;
  • Are transitioning out of transitional housing, or rapid re-housing;
  • Are transitioning out of a homeless shelter/interim housing, including
    domestic violence shelters or domestic violence housing;
  • Meet the criteria of unsheltered homelessness described at 24 CFR part
    91.5 (“An individual or family with a primary nighttime residence that is a public or private place not designed
    for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned
    building, bus or train station, airport, or camping ground.”)
  • Meet eligibility criteria for a Full Service Partnership (FSP) program.

BH CONNECT CMS Application p. 27

Eligibility

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service. Additionally, the individual must meet at least one of the following criteria:

• Any individual who received Housing Transition/Navigation Services Community Support in counties that offer Housing Transition/Navigation Services.
• Individuals who are prioritized for a permanent supportive housing unit or rental subsidy resource through the local homeless Coordinated Entry System or similar system designed to use information to identify highly vulnerable individuals with disabilities and/or one or more serious chronic conditions and/or serious mental illness, institutionalization or requiring residential services because of a substance use disorder and/or is exiting incarceration; or
• Individuals who meet the Housing and Urban Development (HUD) definition of homeless as defined in Section 91.5 of Title 24 of the Code of Federal Regulations (including those exiting institutions but not including any limits on the number of days in the institution) and who are receiving enhanced care management, or who have one or more serious chronic conditions and/or serious mental illness and/or is at risk of institutionalization or requiring residential services as a result of a substance use disorder. For this service, qualifying institutions include hospitals, correctional facilities, mental health residential treatment facility, substance use disorder residential treatment facility, recovery residences, Institution for Mental Disease and State Hospitals. (MediCal Community Supports, or In Lieu of Services (ILOS), Policy Guide, July 2023, p.17)

Eligibility

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service. Additionally, the individual must meet at least one of the following criteria:

• Any individual who received Housing Transition/Navigation Services Community Support in counties that offer Housing Transition/Navigation Services.
• Individuals who are prioritized for a permanent supportive housing unit or rental subsidy resource through the local homeless Coordinated Entry System or similar system designed to use information to identify highly vulnerable individuals with disabilities and/or one or more serious chronic conditions and/or serious mental illness, institutionalization or requiring residential services because of a substance use disorder and/or is exiting incarceration; or
• Individuals who meet the Housing and Urban Development (HUD) definition of homeless as defined in Section 91.5 of Title 24 of the Code of Federal Regulations (including those exiting institutions but not including any limits on the number of days in the institution) and who are receiving enhanced care management, or who have one or more serious chronic conditions and/or serious mental illness and/or is at risk of institutionalization or requiring residential services as a result of a substance use disorder. For this service, qualifying institutions include hospitals, correctional facilities, mental health residential treatment facility,substance use disorder residential treatment facility, recovery residences, Institution for Mental Disease and State Hospitals; or
• Individuals who meet the HUD definition of at risk of homelessness as defined in Section 91.5 of Title 24 of the Code of Federal Regulations as:
  • (1) An individual or family who:
    • Has an annual income below 30 percent of median family income for the
      area, as determined by HUD;
    • Does not have sufficient resources or support networks, e.g., family, friends, faith-based or other social networks, immediately available to prevent them from moving to an emergency shelter or another place described in paragraph (1) of the “Homeless” definition in this section; and
    • Meets one of the following conditions:
      • Has moved because of economic reasons two or more times during the 60 days immediately preceding the application for homelessness prevention assistance;
      • Is living in the home of another because of economic hardship;
      • Has been notified in writing that their right to occupy their current housing or living situation will be terminated within 21 days after the date of application for assistance;
      • Lives in a hotel or motel and the cost of the hotel or motel stay is not paid by charitable organizations or by federal, State, or local government programs for low-income individuals;
      • Lives in a single-room occupancy or efficiency apartment unit in which there reside more than two persons or lives in a larger housing unit in which there reside more than 1.5
        people per room, as defined by the U.S. Census Bureau;
      • Is exiting a publicly funded institution, or system of care (such as a health-care facility, a mental health facility, foster care or other youth facility, or correction program or institution); or
      • Otherwise lives in housing that has characteristics associated with instability and an increased risk of homelessness, as identified in the recipient’s approved consolidated plan;
    • (2) A child or youth who does not qualify as “homeless” under this section, but qualifies as “homeless” under section 387(3) of the Runaway and Homeless Youth Act (42 U.S.C. 5732a(3)), section 637(11) of the Head Start Act (42 U.S.C. 9832(11)), section 41403(6) of the Violence Against Women Act of 1994 (42 U.S.C. 14043e-2(6)), section 330(h)(5)(A) of the Public Health Service Act (42 U.S.C. 254b(h)(5)(A)), section 3(m) of the Food and Nutrition Act of 2008 (7 U.S.C. 2012(m)), or section 17(b)(15) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(b)(15)); or
    • (3) A child or youth who does not qualify as “homeless” under this section but qualifies as “homeless” under section 725(2) of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a(2)), and the parent(s) or guardian(s) of that child or youth if living with her or him.
      Individuals who are determined to be at risk of experiencing homelessness are eligible to receive Housing Tenancy and Sustaining services if they have significant barriers to housing stability and meet at least one of the following:
      • Have one or more serious chronic conditions;
      • Have a Serious Mental Illness;
      • Are at risk of institutionalization or overdose or are requiring residential services because of a substance use disorder o Have a Serious Emotional Disturbance (children and adolescents);
      • Are receiving Enhanced Care Management; or
      • Are a Transition-AgeYouth with significant barriers to housing stability, such as one or more convictions, a history of foster care, involvement with the juvenile justice or criminal justice system, and/or have a serious mental illness and/or a child or adolescent with serious emotional disturbance and/or who have been victims of trafficking or domestic violence. (DHCS Community Supports Policy Guide, or In Lieu of Services (ILOS), Policy Guide, July 2023, p.17)

Eligibility

Individuals 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 meet any of the following criteria:
• Individuals who meet the Housing and Urban Development (HUD) definition of homeless as defined in Section 91.5 of Title 24 of the Code of Federal Regulations (including those exiting institutions but not including any limits on the number of days in the institution) and who are receiving enhanced care management, or who have one or more serious chronic conditions and/or serious mental illness and/or is at risk of institutionalization or requiring residential services as a result of a substance use disorder. For the purpose of this service, qualifying institutions include hospitals, correctional facilities, mental health residential treatment facility, substance use disorder residential treatment facility, recovery residences, Institutions for Mental Disease, and State Hospitals. If exiting an institution, individuals are considered homeless if they were homeless immediately prior to entering that institutional stay, regardless of the length of the institutionalization. The timeframe for an individual or family who will imminently lose housing is extended from fourteen (14) days for individuals considered homeless to thirty (30) days;
• Individuals who meet the HUD definition of at risk of homelessness as defined in Section 91.5 of Title 24 of the Code of Federal Regulations as:
  • (1) An individual or family who:
    • Has an annual income below 30 percent of median family income for the
      area, as determined by HUD;
    • Does not have sufficient resources or support networks, e.g., family, friends, faith-based or other social networks, immediately available to prevent them from moving to an emergency shelter or another place described in paragraph (1) of the “Homeless” definition in this section; and
• Meets one of the following conditions:
  • Has moved because of economic reasons two or more times during the 60 days immediately preceding the application for homelessness prevention assistance;
  • Is living in the home of another because of economic hardship;
  • Has been notified in writing that their right to occupy their current housing or living situation will be terminated within thirty (30) days after the date of application for assistance;
• Lives in a hotel or motel and the cost of the hotel or motel stay is not paid by charitable organizations or by federal, state, or local government programs for low-income individuals;
• Lives in a single-room occupancy or efficiency apartment unit in which there reside more than two persons or lives in a larger housing unit in which there reside more than 1.5 people per room, as defined by the U.S. Census Bureau
  Is exiting a publicly funded institution, or system of care (such as a health-care facility, a mental health facility, foster care or other youth facility, or correction program or institution); or
• Otherwise lives in housing that has characteristics associated with instability and an increased risk of homelessness, as identified in the recipient’s approved consolidated plan;
  • (2) A child or youth who does not qualify as “homeless” under this section, but qualifies as “homeless” under section 387(3) of the Runaway and Homeless Youth Act (42 U.S.C. 5732a(3)), section 637(11) of the Head Start Act (42 U.S.C. 9832(11)), section 41403(6) of the Violence Against Women Act of 1994 (42 U.S.C. 14043e-2(6)), section 330(h)(5)(A) of the Public Health Service Act (42 U.S.C. 254b(h)(5)(A)), section 3(m) of the Food and Nutrition Act of 2008 (7 U.S.C. 2012(m)), or section 17(b)(15) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(b)(15)); or
  • (3) A child or youth who does not qualify as “homeless” under this section but qualifies as “homeless” under section 725(2) of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a(2)), and the parent(s) or guardian(s) of that child or youth if living with her or him.
• Individuals who are determined to be at risk of experiencing homelessness are eligible to receive Short-Term Post-Hospitalization Housing services if they have significant barriers to housing stability and meet at least one of the following:
  • Have one or more serious chronic conditions;
  • Have a Serious Mental Illness;
  • Are at risk of institutionalization or overdose or are requiring residential services because of a substance use disorder
  • Have a Serious Emotional Disturbance (children and adolescents);
  • Are receiving Enhanced Care Management; or
  • Are a Transition Age Youth with significant barriers to housing stability, such as one or more convictions, a history of foster care, involvement with the juvenile justice or criminal justice system, and/or have a serious mental illness and/or a child or adolescent with serious emotional disturbance and/or who have been victims of trafficking or domestic violence.

In addition to meeting one of these criteria at a minimum, individuals must have medical/behavioral health needs such that experiencing homelessness upon discharge from the hospital, substance use or mental health treatment facility, correctional facility, nursing facility, or recuperative care would likely result in hospitalization, re-hospitalization, or institutional readmission. (DHCS Community Supports Policy Guide pg. 26)

Eligibility

Activities must be related to the development of the agency’s capacity to deliver prevention services. See the Core Services Description for an example list of relevant activities.

Eligibility

Children (Members under age 21) and their parent(s)/caregivers(s) are eligible for DBH well-child visits when delivered according to the Bright Futures/American Academy of Pediatrics periodicity schedule for behavioral/social/emotional screening assessment, and when medically necessary, in accordance with EPSDT requirements. Under EPSDT standards, a diagnosis is not required to qualify for services. DBH well-child visits are intended to be universal per the Bright Futures periodicity schedule for behavioral/social/emotional screening assessment. The DBH well-child visits do not need a particular recommendation or referral and must be offered as an appropriate service option even if the Member does not request them. The family is eligible to receive Dyadic Services so long as the child is enrolled in Medi-Cal. The parent(s) or caregiver(s) does not need to be enrolled in Medi- Cal or have other coverage so long as the care is for the direct benefit of the child. (APL 22-029 Revised March 20, 2023).

Eligibility

Determining Candidacy: To qualify for IV-E prevention services, a child must be determined to be at imminent risk of foster care entry by an authorized Title IV-E agency and belong to one of the candidate populations listed below.

There may be multiple pathways for a family to be determined eligible for IV-E funded prevention services.

Community Pathway: Through the community pathway, families can self-refer, or be referred by a public or private entity such as a school, healthcare provider, or local organization. Families may also be referred to the community pathway by a local Title IV-E agency that determines a family is eligible for prevention services but a Family Maintenance case will not be opened. During the intake process, the contracted community pathway provider (such as a Family Resource Center or behavioral health provider) will complete an assessment of the circumstances of the child/family. If the child/family is assessed to need mental health, substance abuse, and/or in-home parenting skill-based services for the child to remain safely at home, they will identify the child as potentially eligible for Title IV-E prevention services to the authorizing Title IV-E agency. The Title IV-E agency determines candidacy. Once candidacy is determined, the contracted provider provides prevention services in coordination with the IV-E agency and other service providers.

Child Welfare Agency pathway: Child welfare agencies may directly assess families and determine eligibility for IV-E prevention services.

Probation Department pathway: Probation agencies may directly assess families and determine eligibility for IV-E prevention services.

Candidacy:

Categories of circumstances under which children are eligible for prevention services funded through IV-E if also meeting the imminent risk determination:

1. Children in voluntary or court-ordered Family Maintenance services cases.
2. Probation minors subject to a petition under section 602 of the Welfare and Institutions Code (WIC), and for whom the probation department determined to be at imminent risk
3. Children whose guardianship or adoption arrangement is at-risk of disruption
4. Children with a” substantiated” or “inconclusive” disposition of a child abuse or neglect allegation, without a case being opened
5. Children who have siblings in foster care are eligible to receive Title IV-E prevention services.
6. Homeless youth: While state law provides that the homelessness itself is not a basis for removal, Title IV-E prevention services provide the opportunity to keep families together by directly addressing certain root causes of homelessness, such as mental health and substance abuse, which may place a child at imminent risk.
7. Substance-exposed newborns, defined as infants born and identified as being affected by substance use or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder, including both illegal and prescribed drugs.
8. Trafficked children are eligible to receive Title IV-E prevention services. These children are at risk of or have experienced commercial sexual exploitation (CSE), as defined in WIC section 300(b)(2).
9. Children exposed to domestic violence
10. Children whose caretakers experience a substance use disorder
11. Children or youth experiencing other risk factors that when combined with family instability or safety threats would be assessed to be at imminent risk of foster care.

While the characteristics of children in the categories above may contribute to their increased risk of foster care, the existence of these characteristics do not, in and of themselves mean that they are likely to enter foster care. In order to be considered “at imminent risk for foster care” an assessment would seek to understand current circumstances that may exacerbate the impact of such characteristics and increase the likelihood that, without intervention, placement may be needed.

(California’s Five-Year State Prevention Plan, CDSS, 2023)

Eligibility

Children (Members under age 21) and their parent(s)/caregivers(s) are eligible for DBH well-child visits when delivered according to the Bright Futures/American Academy of Pediatrics periodicity schedule for behavioral/social/emotional screening assessment, and when medically necessary, in accordance with EPSDT. The family is eligible to receive Dyadic Services so long as the child is enrolled in Medi-Cal. The parent(s) or caregiver(s) does not need to be enrolled in Medi- Cal or have other coverage so long as the care is for the direct benefit of the child. (APL 22-029 Revised March 20, 2023).

Eligibility

Individuals who live in the community and are compromised in their Activities of Daily Living (ADLs) and are therefore dependent upon a qualified caregiver who provides most of their support, and who require caregiver relief to avoid institutional placement.

Other subsets may include children who previously were covered for Respite Services under the Pediatrics Palliative Care Waiver, foster care program beneficiaries, Members enrolled in either California Children’s Services or the Genetically Handicapped Persons Program (GHPP), and Members with Complex Care Needs

Community Supports Policy Guide p 36

To receive these services, an individual must be enrolled as a member of the Managed Care Plan providing the service.

Eligibility

Children (Members under age 21) and their parent(s)/caregivers(s) well-child visits when delivered according to the Bright Futures/American Academy of Pediatrics periodicity schedule for behavioral/social/emotional screening assessment, and when medically necessary, in accordance with Medi-Cal’s EPSDT standards. Under EPSDT standards, a diagnosis is not required to qualify for services. DBH well-child visits are intended to be universal per the Bright Futures periodicity schedule for behavioral/social/emotional screening assessment. The DBH well-child visits do not need a particular recommendation or referral and must be offered as an appropriate service option even if the Member does not request them. The family is eligible to receive Dyadic Services so long as the child is enrolled in Medi-Cal. The parent(s) or caregiver(s) does not need to be enrolled in Medi- Cal or have other coverage so long as the care is for the direct benefit of the child. (APL 22-029 Revised March 20, 2023).

Eligibility

Determining Candidacy: To qualify for IV-E prevention services, a child must be determined to be at imminent risk of foster care entry by an authorized Title IV-E agency and belong to one of the candidate populations listed below.

There may be multiple pathways for a family to be determined eligible for IV-E funded prevention services.

Community Pathway: Through the community pathway, families can self-refer, or be referred by a public or private entity such as a school, healthcare provider, or local organization. Families may also be referred to the community pathway by a local Title IV-E agency that determines a family is eligible for prevention services but a Family Maintenance case will not be opened. During the intake process, the contracted community pathway provider (such as a Family Resource Center or behavioral health provider) will complete an assessment of the circumstances of the child/family. If the child/family is assessed to need mental health, substance abuse, and/or in-home parenting skill-based services for the child to remain safely at home, they will identify the child as potentially eligible for Title IV-E prevention services to the authorizing Title IV-E agency. The Title IV-E agency determines candidacy. Once candidacy is determined, the contracted provider provides prevention services in coordination with the IV-E agency and other service providers.

Child Welfare Agency pathway: Child welfare agencies may directly assess families and determine eligibility for IV-E prevention services.

Probation Department pathway: Probation agencies may directly assess families and determine eligibility for IV-E prevention services.

Candidacy:

Categories of circumstances under which children are eligible for prevention services funded through IV-E if also meeting the imminent risk determination:

Children in voluntary or court-ordered Family Maintenance services cases.
Probation minors subject to a petition under section 602 of the Welfare and Institutions Code (WIC), and for whom the probation department determined to be at imminent risk
Children whose guardianship or adoption arrangement is at-risk of disruption
Children with a” substantiated” or “inconclusive” disposition of a child abuse or neglect allegation, without a case being opened
Children who have siblings in foster care are eligible to receive Title IV-E prevention services.
Homeless youth: While state law provides that the homelessness itself is not a basis for removal, Title IV-E prevention services provide the opportunity to keep families together by directly addressing certain root causes of homelessness, such as mental health and substance abuse, which may place a child at imminent risk.
Substance-exposed newborns, defined as infants born and identified as being affected by substance use or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder, including both illegal and prescribed drugs.
Trafficked children are eligible to receive Title IV-E prevention services. These children are at risk of or have experienced commercial sexual exploitation (CSE), as defined in WIC section 300(b)(2).
Children exposed to domestic violence
Children whose caretakers experience a substance use disorder
Children or youth experiencing other risk factors that when combined with family instability or safety threats would be assessed to be at imminent risk of foster care.
While the characteristics of children in the categories above may contribute to their increased risk of foster care, the existence of these characteristics do not, in and of themselves mean that they are likely to enter foster care. In order to be considered “at imminent risk for foster care” an assessment would seek to understand current circumstances that may exacerbate the impact of such characteristics and increase the likelihood that, without intervention, placement may be needed.

(California’s Five-Year State Prevention Plan, CDSS, 2023)

Eligibility

As specified in APL 22-006, MCPs must provide or arrange for the provision of NSMHS for the following populations:

• Members who are 21 years of age and older with mild-to-moderate distress, or mild-to-moderate impairment of mental, emotional, or behavioral functioning resulting from mental health disorders, as defined by the current Diagnostic and Statistical Manual of Mental Disorders;
• Members who are under the age of 21, to the extent they are eligible for services through the EPSDT benefit, regardless of the level of distress or impairment, or the presence of a diagnosis; and,
• Members of any age with potential mental health disorders not yet diagnosed. In addition to the above requirements, MCPs must provide psychotherapy to members under the age of 21 with specified risk factors or with persistent mental health symptoms in the absence of a mental health disorder. MCPs are also required to cover up to 20 individual and/or group counseling sessions for pregnant and postpartum individuals with specified risk factors for perinatal depression when sessions are delivered during the prenatal period and/or during the 12 months following childbirth. Details regarding NSMHS psychiatric and psychological services, including
psychotherapy coverage, Current Procedural Terminology (CPT) codes that are covered, and information regarding eligible provider types can be found in the Medi-Cal Provider Manual, Non-Specialty Mental Health Services: Psychiatric and Psychological Services.

Family Therapy as a Behavioral Health Benefit

Family therapy is type of psychotherapy covered under Medi-Cal’s NSMHS benefits, including for Members under age 21 who are at risk for behavioral health concerns and for whom clinical literature would support that the risk is significant such that family therapy is indicated, but may not have a mental health diagnosis. Family therapy is composed of at least two family members receiving therapy together provided by a mental health Provider to improve parent/child or caregiver/child relationships and encourage bonding, resolving conflicts, and creating a positive home environment. All family members do not need to be present for each service. For example, parents or caregivers can qualify for family therapy without their infant present, if necessary. The primary purpose of family therapy is to address family dynamics as they relate to the Member’s mental status and behavior(s).

Both children and adult Members can receive family therapy mental health services that are medically necessary. MCPs and are required to provide family therapy to the following Medi-Cal Members to improve parent/child or caregiver/child relationships and bonding, resolve conflicts, and create a positive home environment:

• Members under age 21 with a diagnosis of a mental health disorder;
• Members under age 21 with persistent mental health symptoms in the absence of a mental health disorder;
• Members under age 21 with a history of at least one of the following risk factors: Neonatal or pediatric intensive care unit hospitalization
  • Separation from a parent or caregiver (for example, due to incarceration, immigration, or military deployment)
  • Death of a parent or caregiver
  • Foster home placement
  • Food insecurity, housing instability
  • Maltreatment
  • Severe and persistent bullying
  • Experience of discrimination, including but not limited to discrimination on the basis of race, ethnicity, gender identity, sexual orientation, religion, learning differences, or disability; or
• Members under age 21 who have a parent(s) or caregiver(s) with one or more of the following risk factors:
  • A serious illness or disability
  • A history of incarceration
  • Depression or other mood disorder
  • Post-Traumatic Stress Disorder or other anxiety disorder
  • Psychotic disorder under treatment
  • Substance use disorder
  • Job loss
  • A history of intimate partner violence or interpersonal violence
  • Is a teen parent

Consistent with APL 19-010, or any superseding APL, for Members under age 21, the EPSDT benefit requires that MCPs provide family therapy services if needed to correct or ameliorate a child’s mental health condition. Services that sustain, support, improve, or make more tolerable a mental health condition are considered to ameliorate the condition and are thus covered as EPSDT services. Consistent with APL 19-010, or any superseding APL, for Members under age 21, the EPSDT benefit requires that MCPs provide family therapy services if needed to correct or ameliorate a child’s mental health condition. Services that sustain, support, improve, or make more tolerable a mental health condition are considered to ameliorate the condition and are thus covered as EPSDT services. (APL 22-029 pg 6)

Eligibility

Determining Candidacy: To qualify for IV-E prevention services, a child must be determined to be at imminent risk of foster care entry by an authorized Title IV-E agency and belong to one of the candidate populations listed below.

There may be multiple pathways for a family to be determined eligible for IV-E funded prevention services.

Community Pathway: Through the community pathway, families can self-refer, or be referred by a public or private entity such as a school, healthcare provider, or local organization. Families may also be referred to the community pathway by a local Title IV-E agency that determines a family is eligible for prevention services but a Family Maintenance case will not be opened. During the intake process, the contracted community pathway provider (such as a Family Resource Center or behavioral health provider) will complete an assessment of the circumstances of the child/family. If the child/family is assessed to need mental health, substance abuse, and/or in-home parenting skill-based services for the child to remain safely at home, they will identify the child as potentially eligible for Title IV-E prevention services to the authorizing Title IV-E agency. The Title IV-E agency determines candidacy. Once candidacy is determined, the contracted provider provides prevention services in coordination with the IV-E agency and other service providers.

Child Welfare Agency pathway: Child welfare agencies may directly assess families and determine eligibility for IV-E prevention services.

Probation Department pathway: Probation agencies may directly assess families and determine eligibility for IV-E prevention services.

Candidacy:

Categories of circumstances under which children are eligible for prevention services funded through IV-E if also meeting the imminent risk determination:

1. Children in voluntary or court-ordered Family Maintenance services cases.
2. Probation minors subject to a petition under section 602 of the Welfare and Institutions Code (WIC), and for whom the probation department determined to be at imminent risk
3. Children whose guardianship or adoption arrangement is at-risk of disruption
4. Children with a” substantiated” or “inconclusive” disposition of a child abuse or neglect allegation, without a case being opened
5. Children who have siblings in foster care are eligible to receive Title IV-E prevention services.
6. Homeless youth: While state law provides that the homelessness itself is not a basis for removal, Title IV-E prevention services provide the opportunity to keep families together by directly addressing certain root causes of homelessness, such as mental health and substance abuse, which may place a child at imminent risk.
7. Substance-exposed newborns, defined as infants born and identified as being affected by substance use or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder, including both illegal and prescribed drugs.
8. Trafficked children are eligible to receive Title IV-E prevention services. These children are at risk of or have experienced commercial sexual exploitation (CSE), as defined in WIC section 300(b)(2).
9. Children exposed to domestic violence
10. Children whose caretakers experience a substance use disorder
11. Children or youth experiencing other risk factors that when combined with family instability or safety threats would be assessed to be at imminent risk of foster care.

While the characteristics of children in the categories above may contribute to their increased risk of foster care, the existence of these characteristics do not, in and of themselves mean that they are likely to enter foster care. In order to be considered “at imminent risk for foster care” an assessment would seek to understand current circumstances that may exacerbate the impact of such characteristics and increase the likelihood that, without intervention, placement may be needed.

(California’s Five-Year State Prevention Plan, CDSS, 2023)