Enhanced Care Management

If you are covered by Medi-Cal, you have a benefit that is helpful for people who could use extra support.

Enhanced Care Management (ECM) is for members with complex medical and social needs. Some people also call this Medi-Cal benefit ECM. ECM helps members find and coordinate care based on their needs. 

If you qualify for ECM, you will have your own care team with a Lead Care Manager. This person will work with you and your doctors, specialists, and others. They make sure everyone works together to get you the care you need!

ECM may provide support for you, your family, and caretakers at no cost.
ECM may provide support for you, your family, and caretakers at no cost.

ECM services include:

  • Regular doctor visits for preventative care when you are sick
  • Specialty Care Visits
  • Help with housing or shelter
  • Behavioral health and mental health services
  • Substance use disorder treatment
  • Developmental health
  • Oral health (dental)
  • Long-term services and supports (LTSS)
  • Referrals to community resources in your area

This is further mentioned within your Evidence of Coverage booklet.

Who qualifies for ECM?
  • 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
  • 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
  • Adults Living in the Community and At Risk for Long Term Care (LTC) Institutionalization
  • Adults Nursing Facility Residents Transitioning to the Community
  • 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
  • Pregnant and Postpartum Individuals At Risk for Adverse Perinatal Outcomes who are subject to racial and ethnic disparities
  • Individuals Transitioning from Incarceration
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.

How do I get an ECM referral?

You can self refer. This means you can call Health Plan and ask to be referred for services. Call 1-888-936-7526 (PLAN) TTY 711.

  • You may be contacted about ECM services based on what we know about you and the other types of services you get.
  • Talk to your doctor or other health care provider and ask them to help you find out if you qualify for ECM.

Community Support Services

Community Support Services (CSS) are optional, no cost services available to members. These services can help members live more independently and have a better quality of life. Community Supports are alternative services to those covered under the Medi-Cal State Plan. They do not replace benefits that members already get under Medi-Cal. 

You can find more details about this benefit in your Evidence of Coverage booklet.

enhanced care management

List of services that are covered:

  • 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.
How do I get a CSS referral?

You can self refer. This means you can call Health Plan and ask to be referred for services. Call 1-888-936-7526 (PLAN) TTY 711.

  • You may be contacted about CSS services based on what we know about you and the other types of services you get.
  • Talk to your doctor or other health care provider and ask them to help you find out if you qualify for CSS.

If you have any questions about ECM or CSS, talk to your doctor or call Health Plan at
1-888-936-7526 (PLAN) TTY 711.

Posted on September 27th, 2024 and last modified on February 7th, 2025.

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