Home Modification

CalAIM Environmental Accessibility Adaptations (Home Modifications) — Complete Program Description

What Is the Program?

Environmental Accessibility Adaptations (EAAs), also known as Home Modifications, are physical adaptations to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home — without which the member would require institutionalization. Contra Costa Health

This is one of 14 Community Supports available under CalAIM, funded through Medi-Cal at no cost to eligible members. The program's core mission is straightforward: make the home safe enough and accessible enough that a member can stay in it, rather than being placed in a nursing facility or other institutional setting.

The program makes physical adaptations to a home environment that are necessary to ensure member health, welfare, and safety, or enable members to function with greater independence in the home and avoid institutionalization. CalOptima

🔨 What Home Modifications Are Covered

Environmental Accessibility Adaptations include grab bars, ramps, doorway widening, accessible bathroom conversions, stair lifts, wheelchair ramps, and stair railings. The full list of covered modifications includes: Homesafety

1. Mobility and Access Modifications

Wheelchair ramps — exterior and interior ramps to allow wheelchair users to enter and navigate the home

Doorway widening — expanding doorways to accommodate wheelchairs, walkers, and other mobility devices

Stair lifts and chair lifts — motorized lifts to allow members who cannot climb stairs to access all floors of their home

Stair railings and handrails — installing or reinforcing railings along stairs and hallways to prevent falls

Threshold modifications — lowering or removing doorway thresholds that create tripping hazards or block wheelchairs

2. Bathroom Safety Modifications

Grab bars — installation in bathrooms, showers, bathtubs, and near toilets to prevent falls and support balance

Accessible bathroom conversions — converting standard tubs or showers into roll-in showers or walk-in accessible shower stalls

Handheld shower heads — for members who cannot stand while bathing

Raised toilet seats and toilet safety frames — to assist members with limited mobility in sitting and standing

Non-slip flooring — in bathrooms and other high-risk wet areas

3. Specialized Electrical and Plumbing Systems

Installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies of the member. This includes: Contra Costa Health

Electrical upgrades to support medical equipment such as oxygen concentrators, ventilators, or home dialysis machines

Dedicated circuits for power wheelchairs and motorized scooters

Plumbing modifications required for medical or hygiene equipment

Wiring for medical alert or monitoring devices

4. Personal Emergency Response System (PERS)

Installation and testing of a Personal Emergency Response System (PERS) for members who are alone for significant parts of the day without a caregiver and who otherwise require routine supervision, including monthly service costs as needed. This covers: Contra Costa Health

The PERS device itself (typically a wearable button or pendant)

Installation and setup

Ongoing monthly monitoring service fees

Testing and member training on how to use the system

This benefit is especially valuable for seniors and people with disabilities who live alone and are at risk of falling or experiencing a medical emergency without anyone present to help.

5. Finishing Work

EAAs may include finishing such as drywall and painting to return the home to a habitable condition, but do not include aesthetic embellishments. This means that when a structural modification is made — such as widening a doorway or installing a ramp — the finishing work needed to make the home livable again after construction is also covered. Iehp

✅ Who Is Eligible

To qualify for Home Modifications, a Medi-Cal managed care member must meet all of the following:

Members are eligible for Home Modifications when all of the following are met: the member is at risk of institutionalization in a nursing facility; signed landlord consent is provided for the requested equipment or service; clinical documentation from the member's current primary care physician or other health professional specifies the requested equipment or service; and documentation from the provider of the equipment or service describes how the equipment or service meets the medical needs of the member. Iehp

In plain terms, eligible members typically include:

Older adults who are at risk of nursing home placement due to fall risk, mobility limitations, or inability to safely function at home

People with physical disabilities including wheelchair users and those with limited mobility who need structural changes to remain in their home

People with chronic conditions such as COPD, congestive heart failure, or neuromuscular diseases who require medical equipment with special electrical or plumbing needs

People living alone without a caregiver who need a PERS device for safety

Members transitioning from nursing facilities or hospitals who need their home modified before they can safely return

🏠 Where Services Can Be Provided

The services are available in a home that is owned, rented, leased, or occupied by the member. This means it does not matter whether the member owns or rents their home — renters are fully eligible. Contra Costa Health

For a home that is not owned by the member, the member must provide written consent from the owner for physical adaptations to the home or for equipment that is physically installed in the home, such as grab bars or chair lifts. CA

📋 Authorization and Clinical Documentation Requirements

When authorizing environmental accessibility adaptations as a Community Support, the MCP must receive and document an order from the member's current primary care physician or other health professional specifying the requested equipment or service, as well as documentation from the provider of the equipment or service describing how the equipment or service meets the medical needs of the member. Brochures will suffice to show the purpose and efficacy of the equipment; however, a brief written evaluation specific to the member describing how and why the equipment or service meets the needs of the member will still be necessary. CA

The assessment and authorization for EAAs must take place within a 90-day time frame beginning with the request for the EAA, unless more time is required to receive documentation of homeowner consent, or the individual receiving the service requests a longer time frame. Contra Costa Health

💰 Program Limits and Parameters

ParameterDetailCost to member$0 — fully covered through Medi-CalLifetime maximum$7,500 per memberExceptions to the capIf the member moves to a new residence, or if the member's condition has changed significantly enough to require additional modificationsBuilding code complianceAll physical adaptations must comply with applicable state and local building codesLicensed contractor requiredAll EAAs that are physical adaptations to a residence must be performed by an individual holding a California Contractor's License, except for a PERS installation which may be performed in accordance with the system's installation requirements. IehpAesthetic work excludedModifications must be of direct medical or remedial benefit — general improvements or aesthetic upgrades are not coveredSquare footage exclusionAdaptations that add to the total square footage of the home are excludedAvailable statewideYes — offered in all 58 California counties through contracted MCPs

❌ What Is NOT Covered

Modifications that are of general utility to the household but not specifically tied to the member's medical needs

Aesthetic improvements or renovations (new paint, flooring upgrades, remodeling)

Additions that expand the square footage of the home

Repairs or maintenance of modifications after they are installed — before commencement of a physical adaptation, the managed care plan must provide the owner and member with written documentation that the modifications are permanent, and the state is not responsible for maintenance or repair of any modification nor for removal of any modification if the member ceases to reside at the residence. Iehp

Services already covered by other Medi-Cal state plan benefits such as Durable Medical Equipment (DME) — EAA supplements, not duplicates, existing coverage

📈 Proven Outcomes and Cost Savings

Analysis of Q4 2023 through Q3 2024 data demonstrates substantial reductions in high-cost healthcare utilization. Environmental Accessibility Adaptations are proving effective at diverting nursing home admissions and empowering Medi-Cal members to live safely and independently in their homes. Homesafety

Environmental Accessibility Adaptations ranked among the top five most cost-effective Community Supports evaluated. Home Modification interventions offer a practical, evidence-based path to reducing long-term care costs while improving member health and independence. Evolve-emod

The evidence shows that targeted home modifications deliver three key outcomes:

Fall prevention — grab bars, ramps, and handrails directly reduce fall-related emergency room visits and hospitalizations

Nursing facility diversion — members who can safely remain at home avoid costly institutional placements

Long-term care cost reduction — data show an 8.7% reduction in per-member-per-month long-term care costs among members who receive home modifications

🔗 How Home Modifications Work With Other CalAIM Programs

Members may receive Housing Transition Navigation Services, Housing Deposits, and/or Environmental Accessibility Adaptations at the same time as other Community Supports as long as the services provided are nonduplicative, distinct, and necessary. CA

Home modifications are particularly powerful when combined with:

Housing Deposits — a member moving into a new apartment can receive Housing Deposits for move-in costs AND Home Modifications to make the new unit safe and accessible

Personal Care and Homemaker Services — modifications reduce the physical burden on caregivers and extend the number of hours a member can safely live independently

Enhanced Care Management (ECM) — ECM Lead Care Managers identify members who need home modifications and coordinate the authorization and installation process

Community Transition Services — members leaving nursing facilities to return home can receive home modifications to ensure the home is safe before or immediately after discharge

How to Access the Program

Any of the following can initiate a referral for Home Modifications:

The member or their family by self-referral to their Medi-Cal Managed Care Plan

A primary care physician or specialist who identifies safety or mobility concerns

A hospital discharge planner preparing a member to return home from inpatient care

An ECM Lead Care Manager during care coordination

A home health provider or occupational therapist conducting a home safety assessment