Housing Tenancy Sustaining Services (HTSS)

3. Landlord Relationship Coaching and Coordination

HTSS provides coaching on developing and maintaining key relationships with landlords and property managers with a goal of fostering successful tenancy, and coordination with the landlord and case management provider to address identified issues that could impact housing stability. Specific services include: Partnershiphp

Coaching the member on how to communicate respectfully and proactively with their landlord

Mediating conversations between the member and landlord when communication has broken down

Notifying the landlord about a member's health condition or disability when the member consents, to support mutual understanding and reasonable accommodations

Working with property management on behalf of the member to resolve complaints before they become formal violations

Facilitating reasonable accommodation requests under Fair Housing law for members with disabilities

Maintaining an open line of communication between the HTSS provider, the member, and the landlord to catch and address problems early

4. Dispute Resolution and Eviction Prevention

HTSS provides assistance in resolving disputes with landlords and/or neighbors to reduce the risk of eviction or other adverse action, including developing a repayment plan or identifying funding in situations in which the member owes back rent or payment for damage to the unit. It also provides advocacy and linkage with community resources to prevent eviction when housing is or may potentially become jeopardized. Lovefocushcbs

This is one of the most critical benefits of HTSS. When a member is at risk of eviction, the HTSS provider steps in as an active advocate:

Responding immediately when an eviction notice is issued or threatened

Helping the member understand their rights under California eviction law

Negotiating with landlords on the member's behalf to resolve disputes, create repayment plans, or reach agreements that allow the member to stay

Connecting members to emergency rental assistance programs, legal aid organizations, and other resources when back rent is owed

Advocating with the landlord that an eviction would be harmful and unnecessary when the underlying issue is being addressed

Coordinating with the member's mental health, substance use, or medical providers when a health crisis is driving housing instability

5. Benefits Advocacy and Financial Supports

HTSS assists with benefits advocacy, including assistance with obtaining identification and documentation for SSI eligibility and supporting the SSI application process. Such services can be subcontracted out to retain the needed specialized skillset. Lovefocushcbs

For many HTSS members, their ability to stay housed depends directly on having stable income. Benefits advocacy services include:

Assisting with SSI/SSP application and appeals processes

Helping members maintain and recertify benefits such as CalFresh (food stamps), Medi-Cal, General Relief, and Section 8 housing vouchers

Obtaining vital documents such as California IDs, Social Security cards, and birth certificates needed for benefit enrollment

Connecting members to rep payee services when needed to help manage finances and ensure rent is paid consistently

Helping set up automatic rent payment arrangements such as having rent automatically deducted from SSI benefits

Identifying and accessing emergency financial assistance programs when a member faces a short-term gap that could threaten their tenancy

Financial coaching on budgeting, managing monthly expenses, and avoiding late payments

6. Annual Recertification Assistance

HTSS assists with the annual housing recertification process. For members in subsidized housing programs such as Section 8, permanent supportive housing, or public housing, annual recertification is a requirement that — if missed — can result in loss of the subsidy and the unit. HTSS providers: Lovefocushcbs

Track upcoming recertification deadlines and provide reminders well in advance

Gather and organize the documents needed for recertification including income verification, bank statements, and household member information

Accompany the member to recertification appointments when needed

Assist in completing all required forms accurately and on time

Follow up with the housing authority or property management to resolve any issues arising from the recertification process

7. Independent Living Skills and Daily Life Coaching

HTSS includes budgeting and daily living skills support. For members who have lived outside for extended periods or who have never maintained their own household, building independent living skills is essential to long-term housing stability. Skills coaching includes: Cencalhealth

Budgeting — helping members understand their income, expenses, and how to plan for monthly rent and bills

Household management — cleaning, maintenance, and keeping the unit in acceptable condition to avoid lease violations

Neighbor relations — how to be a good neighbor, manage shared spaces, and resolve conflicts without jeopardizing tenancy

Routine building — establishing daily routines that support health, self-care, and timely bill payment

Community integration — connecting members to local resources, activities, and social support networks to reduce isolation

Transportation skills — navigating public transit and other transportation options to get to appointments and services

8. Health and Safety Check-Ins

HTSS includes health and safety check-ins. Regular home visits and check-ins serve multiple purposes — they ensure the member is safe, identify emerging health or housing concerns early, and maintain the supportive relationship between the member and their HTSS provider. These visits: Cencalhealth

Assess the member's current health, safety, and wellbeing within the home

Check that the unit remains safe, clean, and habitable

Identify any maintenance issues that the landlord is responsible for addressing

Provide an opportunity for the member to raise concerns, ask questions, and get support

Serve as early warning visits that catch potential housing crises before they become irreversible

9. Housing Support Plan Development and Regular Updates

HTSS coordinates with the tenant to review, update, and modify their housing support and crisis plan on a regular basis to reflect current needs and address existing or recurring housing retention barriers. The housing support plan is a living document that: Lovefocushcbs

Identifies the member's specific housing stability goals and the barriers they face

Outlines the specific HTSS services the member will receive and the frequency of contact

Includes a housing crisis plan describing what steps will be taken if the member's tenancy is threatened

Is reviewed and updated regularly — typically at least every 90 days — to reflect changes in the member's situation

Is developed collaboratively with the member to ensure it reflects their priorities and preferences

10. Connection to Other Community Supports and Services

HTSS providers actively connect members to additional resources that support long-term housing stability, including:

Transitional Rent — connecting eligible members to up to six months of rental assistance

Enhanced Care Management (ECM) — ongoing care coordination across physical health, behavioral health, and social needs

Personal Care and Homemaker Services — in-home assistance for members with functional limitations

Home Modifications (Environmental Accessibility Adaptations) — making the home safe and accessible for members with mobility or health-related needs

Behavioral health services — mental health treatment, substance use disorder programs, and peer support

Legal aid organizations — for members facing formal eviction proceedings or other legal challenges

Coordinated Entry System — connecting members to permanent supportive housing resources and long-term rental subsidies when available

✅ Who Is Eligible

Members 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 criteria. Iehp

Eligibility requirements from the DHCS Policy Guide and managed care plan criteria include:

Housing Status — must meet ONE of the following:

Currently experiencing homelessness (meeting the HUD definition)

At risk of homelessness, including those at risk of losing their current housing

Prioritized for permanent supportive housing or a rental subsidy through the Coordinated Entry System

Clinical/Risk Criteria — must meet ONE of the following:

Has a serious chronic condition or serious mental illness; is at risk of institutionalization or needs SUD services; or is enrolled in ECM. Cencalhealth

Additional Pathways: Housing Tenancy Sustaining Services are also available to transition-age youth who have significant barriers to housing stability. California Health Care Foundation

Members who previously received Housing Transition Navigation Services are naturally the primary population for HTSS — they have just been housed and need ongoing support to maintain that housing. However, members who are already housed but at risk of losing their housing can also access HTSS directly without first receiving HTNS.

⏱️ Duration and Frequency

One of the most distinctive and powerful features of HTSS is its flexibility. These services must be identified as reasonable and necessary in the member's housing support plan. Service duration can be as long as necessary. There is no limit on how many times an eligible member may be authorized for HTSS. CA

This is critically different from most other CalAIM programs which have strict time limits. HTSS recognizes that the support needed to maintain housing after long-term homelessness does not end after six months or a year — some members will need periodic support for years, and others may need an intense period of support during a crisis followed by a less intensive maintenance phase.

The frequency and intensity of HTSS services are tailored to the individual member's needs as documented in their housing support plan and reviewed regularly.

📊 Program Parameters at a Glance

ParameterDetailCost to member$0 — fully covered through Medi-CalDurationAs long as necessary — no time limitNumber of authorizationsNo lifetime limit — can be reauthorized as neededMinimum requirementMember must already be housed (or have been housing assessed/screened)Housing support planRequired — must document services as reasonable and necessaryAvailable statewideYes — in all counties through contracted MCPsParticipationVoluntary — members may disenroll at any time

❌ What HTSS Does NOT Cover

Rent payments — HTSS does not pay rent; that is covered by Transitional Rent for eligible members

Move-in costs or deposits — those are covered by the Housing Deposits program

Clinical treatment — HTSS is a housing support service, not a medical or mental health treatment service; clinical needs are addressed through regular Medi-Cal benefits and ECM

Services that duplicate other funded programs — HTSS supplements, not supplants, other state and local housing services

🔗 HTSS and the Full Housing Continuum

After housing is secured, members can receive Housing Tenancy Sustaining Services to help maintain housing. HTSS is the long-term anchor at the end of the full housing support continuum: Justice in Aging

HOUSING TRANSITION NAVIGATION SERVICES → Find housing, apply, conduct assessment ↓ HOUSING DEPOSITS → Security deposit, utilities, household setup ↓ TRANSITIONAL RENT (eligible members) → Up to 6 months rental assistance ↓ HOUSING TENANCY AND SUSTAINING SERVICES ← You are here → Ongoing, indefinite support to stay housed → Eviction prevention, landlord mediation → Benefits advocacy, recertification → Life skills coaching, crisis planning → Health and safety check-ins

📖 Real-World Example

A homeless services provider helped a member maintain his housing after he moved into an apartment. Since he had lived outdoors for many years and wasn't accustomed to paying rent, he initially fell behind on payments, but his tenancy and sustaining services case manager helped advocate to the landlord to prevent his eviction and arranged for his rent to be deducted from his SSI check automatically. The case manager also worked with him when it came time to recertify for his financial benefits. California Health Care Foundation

This example captures the essence of HTSS: it is not enough to simply get someone housed. Long-term homelessness, mental illness, and chronic health conditions create real barriers to independent housing management that — without targeted support — will result in re-homelessness. HTSS provides the consistent, flexible, person-centered support that allows these individuals to not just be briefly housed, but to build lasting stability in their community.

How to Access HTSS

Referrals to HTSS can be made by:

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

An HTNS provider who has been working with the member during the housing search process — a warm handoff at move-in is the most common pathway

A primary care provider, psychiatrist, or case manager identifying a housed member who is at risk of losing their housing

An ECM Lead Care Manager coordinating comprehensive care for the member

A hospital discharge planner for members being discharged to existing housing who need tenancy support

Community organizations working with homeless or formerly homeless individuals