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
Enhanced Care Management
Enhanced Care Management (ECM) is a benefit offered to HPSJ members with complex needs at no cost to the member. It provides extra services to help you get the care you need to stay healthy. It coordinates the care you get from different doctors.
ECM helps coordinate:
- Primary care
- Acute care
- Behavioral health
- Developmental health
- Oral health
- Community-based long-term services and supports (LTSS)
- Referrals to available community resources
Services covered under ECM include:
- Outreach and engagement
- Comprehensive assessment and care management
- Enhanced coordination of care
- Health promotion
- Comprehensive transitional care
- Member and family support services
- Coordination and referral to community and social 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
- Children and Youth with I/DD
- 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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| 2024 (Date TBD) |
- 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:
- You
- Your doctors
- Specialists
- Pharmacists
- Case managers
- Social Services providers
- Others
A Lead Care Manager can also help you find and apply for other services in your community.
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.
HPSJ offers these Community Supports:
- Housing Transition Navigation Services
- Housing Deposits
- Housing Tenancy and Sustaining Services
- Short-Term Post Hospitalization Housing
- Recuperative Care
- Medically Tailored Meals/Medically-Supportive Food
- Sobering Center
- Asthma Remediation
- Environmental Accessibility Adaptations (Home Modifications)
- Day Habilitation Programs
- Personal Care and Homemaker Services
- Respite Services
- Nursing Facility Transition/Diversion to Assisted Living Facilities (Effective July 2023)
- Community Transition Services/Nursing Facility Transition to a Home (Effective July 2023)
ECM/CS Referrals
How do I get an ECM or CS referral?
- You can self refer
- You may be contacted about ECM/CS services
- Talk to your health care provider who can find out if you qualify for ECM/CS and when and how you can receive it.
- You can also call HPSJ to find out if and when you can receive ECM/CS.
If you have any questions about ECM or Community Supports, contact your health care provider or HPSJ at 888.936.7526, TTY 711.
