California Advancing and Innovating Medi-Cal (CalAIM)
Enhanced Care Management & Community Supports
California seeks to improve the Medi-Cal program for people with complex needs and who are facing difficult life and health circumstances. These new services are focused on providing assistance beyond traditional medical services. They are designed to address health and other factors in people’s lives that influence their health. Enhanced Care Management (ECM) and Community Supports (CS) are the names of two new, statewide Medi-Cal services.
The sections below are mentioned within your Evidence of Coverage booklet.
Go to Community Supports
Who qualifies for ECM?
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January 1, 2022
San Joaquin County
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- Adults and their Families Experiencing Homelessness
- Adults At Risk for Avoidable Hospital or Emergency Department (EDO) Utilization (formerly “High Utilizers)
- Adults with Serious Mental Health and/or Substance Use Disorder (SUD) Needs
- Individuals Transitioning from Incarceration (some Whole Person Care (WPC) counties)
- Adults with Intellectual or Developmental Disabilities (I/DD)
- Pregnant or Postpartum Adults
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| July 1, 2022
Stanislaus County |
- Adults and Families Experiencing Homelessness
- Adults at Risk for Avoidable Hospital or ED Utilization
- Adults with Serious Mental Health and/or SUD Needs
- Adults with Intellectual or Developmental Disabilities (I/DD)
- Pregnant or Postpartum Adults
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| January 1, 2023 |
- Adults Living in the Community and At Risk for Long Term Care (LTC) Institutionalization
- Adults Nursing Facility Residents Transitioning to the Community
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| July 1, 2023 |
- Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
- Children and Youth Populations of Focus
- Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
- Children and Youth At Risk for Avoidable Hospital or ED Utilization
- Children and Youth with Serious Mental Health and/or SUD Needs
- Children and Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS Condition
- Children and Youth Involved in Child Welfare
- Pregnant or Postpartum Youth
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| January 1, 2024 |
- Pregnant and Postpartum Individuals At Risk for Adverse Perinatal Outcomes who are subject to racial and ethnic disparities
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| January 1, 2024 |
- Individuals Transitioning from Incarceration
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What is a Lead Care Manager?
Once enrolled in ECM, your ECM provider will assign you a Lead Care Manager. They are a part of your care team. They help coordinate care between:
Community Supports
Community Supports are medically appropriate and cost-effective alternative services or settings to those covered under the Medi-Cal State Plan. These services are optional for Members to receive. If you qualify, these services may help you live more independently. They do not replace benefits that you already get under Medi-Cal.
California seeks to improve the Medi-Cal program for people with complex needs and who are facing difficult life and health circumstances. These new services are focused on providing assistance beyond traditional medical services. They are designed to address health and other factors in people’s lives that influence their health. Enhanced Care Management (ECM) and Community Supports (CS) are the names of two new, statewide Medi-Cal services.
The information below is further mentioned within your Evidence of Coverage booklet.
Health Plan offers these Community Supports:
- Housing Transition Navigation Services: assistance to obtain housing. This may include assistance with searching for housing or completing any housing applications if appropriate and authorized by Health Plan.
- Housing Deposits: Health Plan to provide one-time funding to establish basic housing, including assistance with security deposits to obtain a lease or assisting with first month’s coverage of utilities or rent.
- Housing Tenancy and Sustaining Services: assistance helping residents keep safe and stable housing once housing is secured.
- Short-Term Post Hospitalization Housing: provides those that do not have a residence, and who have a high medical or behavioral health needs, a place to recover after a hospital or facility stay.
- Recuperative Care (Medical Respite): short term housing for those who no longer require hospitalization but need to heal from an injury or illness.
- Medically Tailored Meals/Medically-Supportive Food: meals that are delivered to the home that are tailored to meet members dietary needs.
- Sobering Center: an alternate, short-term location to sober for those who are found to be under the influence in public and would otherwise be transported to emergency services or jail.
- Asthma Remediation: physical changes to the home that are necessary to help members live in the home without environment or asthma-related triggers.
- Environmental Accessibility Adaptations (Home Modifications): physical changes to the home to allow individual to function with greater independence and not require care in a nursing facility.
- Day Habilitation Programs: Programs designed to provide the member in obtaining and improving self-help, social skills, and adaptive skills to live successfully in a natural environment.
- Personal Care and Homemaker Services: Services provided to individuals who need assistance with activities of daily life like bathing, dressing, feeding, housekeeping, or grocery shopping.
- Respite Services: Short-term services provided to caregivers of those who require occasional temporary supervision to give relief to the caregiver.
- Nursing Facility Transition/Diversion to Assisted Living Facilities: Services to help members live in the community and avoid nursing facility stays when possible.
- Community Transition Services/Nursing Facility Transition to a Home: Services to help members live in the community and avoid further institutionalization by providing non-recurring set up expenses for individuals transitioning from a licensed facility to a living arrangement in a private residence.
