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Background:

In 2022, the California Department of Health Care Services (DHCS) operationalized the California Advancing and Innovating Medi-Cal (CalAIM) program to broaden preventative, personalized, and integrated care for those within the US’s largest Medicaid program, Medi-Cal. This included the expansion of post-acute transitional housing Community Supports (CS) like Recuperative Care (RC), known to be a cost-effective and resource-appropriate alternative to inpatient hospitalization for those with unstable housing. DHCS contracted with UCLA for formal required evaluation to assess these novel services and their impact on Medi-Cal recipients.

Objective

To describe the experience of individuals receiving post-acute care in Recuperative Care facilities through direct interview using a formal survey instrument.

Methods:

The survey was designed to characterize the perspective, goals, and satisfaction of residents during their tenure in RC facilities. An extensive literature review was undertaken to gain understanding of best practices for querying persons experiencing homelessness about complex topics like goals and self-efficacy. Question items and scales were constructed following input on cultural norms from existing RC facility resident experience surveys or adapted from operational, validated tools (i.e. Consumer Assessment of Healthcare Providers and Systems (CAHPS®) & RAND Homelessness Survey). Additional items were incorporated to obtain important past social, behavioral health, and substance use history as predictors for success in RC. All items were compared for redundancy and length with a target duration of 30-minutes.

Statewide RC facilities were identified using Medi-Cal claims data (2024) and non-profit partner networks. Recruitment took place over weeks of coordinated email and phone outreach to facility representatives. Survey pilot testing is planned for early Summer 2026 within two organizations and six facilities. Responses will be collected electronically by members of the evaluation team using REDCap and analyzed within R / R studio with univariate descriptives. Survey domain sub-scores will be compared to other known population sub-scores.

Results:

A 90-question survey was developed to include measures within domains related to: goals, RC staff, environment, and satisfaction, health & well-being, history (mental health, substance use, housing), future plans, confidence, and demographics. Responses will be collated with resident past and future Medi-Cal claims data and abstraction of RC facility records for a comprehensive understanding of the resident’s experience utilizing this CS.

As of mid-April 2026, 49 of 128 known RC facilities (38.3%) representing 1,993 RC beds of 4,636 known RC beds (43.0%) have expressed interest in participating in the survey. Of the 49 interested facilities, 28 (57.1%) have returned self-reported characteristics. Most facilities are in greater Southern California (21, 75.0%) and standalone buildings (15, 50.0%). Inpatient hospital stays (24, 80.0%), emergency departments (13, 43.3%), and substance-use disorder providers (7, 23.3%) were the largest sources of referrals. The median number of total RC beds at facilities are 22 with a range from 5-277.

Conclusions:

UCLA’s CalAIM evaluation will be the most comprehensive primary data collection of the experience of persons using RC services to date. Its results will inform both state and local public health and policy efforts to better care for persons with unstable housing in the post-acute care setting.