ENHANCED CARE MANAGEMENT

ABOUT ECM
POPULATIONS OF FOCUS
Core Services
RESOURCES
TRAINING

What is Enhanced Care Management?

Enhanced Care Management (or ECM) is a Medi-Cal managed care benefit that addresses the clinical and non-clinical needs of high-need, high-cost individuals through the coordination of services and comprehensive care management.

Enhanced Care Management benefits give Medi-Cal members with complex needs the support that will help them stay healthy and thrive.

These benefits are designed to support the following nine Populations of Focus.

Populations of Focus

Individuals Experiencing Homelessness

Adults experiencing homelessness with at least one complex physical, behavioral, or developmental need

Children, youth, and families with members under 21 years old experiencing homelessness

Individuals At Risk for Avoidable Hospital or Emergency Department Utilization

Adultswith five or more avoidable ED visits or three or more avoidable unplanned hospital or nursing facility stays in the past year

Children and youth with 3 or more avoidable ED visits or 2 or more avoidable unplanned hospital or nursing facility stays in the past year

Individuals with Serious Mental Health and/or Substance Use Disorder Needs

Adultswith significant mental health or substance use disorders, affected by at least one complex social factor* and one or more of the following: at high risk or institutionalization, overdose, or suicide; rely mainly on crisis services, EDs, urgent care, or inpatient stays; or have had 2+ ED visits or hospitalizations for mental health or substance use disorders in the last 12 months

Children and youth experiencing significant challenges with mental health conditions or substance use disorders

Individuals Transitioning from Incarceration

Adultsreleased from prison, jail, or correctional facilities in the last 12 months and experiencing one or more of the following: mental illness, substance use disorder (SUD), chronic or significant non-chronic clinical condition, intellectual or developmental disability, traumatic brain injury, HIV/AIDS, or pregnancy/postpartum

Children and youth released from youth correctional facilities in the past year

Adults in the Community at Risk for Long-Term Care Institutionalization

Adults living in the community who meet skilled nursing facility criteria or need lower-acuity skilled nursing, are affected by at least one complex social factor*, and can reside in the community with comprehensive support

*Examples of complex social factors include, but are not limited to, lack of access to food; lack of access to stable housing; difficulty accessing transportation; four or more ACEs; recent contacts with law enforcement; or crisis intervention services related to mental health and/or substance use symptoms.

Adult Nursing Facility Residents Transitioning to the Community

Adult nursing facility residents who are interested in moving out, likely candidates to do so successfully, and able to reside continuously in the community

Children and Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs

Children and youth in CCS or CCS WCM who are affected by at least 1 complex social factor*

 *Examples of complex social factors include, but are not limited to, lack of access to food; lack of access to stable housing; difficulty accessing transportation; four or more ACEs; recent contacts with law enforcement; or crisis intervention services related to mental health and/or substance use symptoms.

Children and Youth Involved in Child Welfare

Children and youth meeting any of the following criteria: currently in foster care, received foster care in the last 12 months, aged out of foster care up to age 26, eligible for or participating in California’s Adoption Assistance Program, or receiving or have received California’s Family Maintenance program in the last 12 months

 

Birth Equity Population of Focus

Black, American Indian, Alaska Native, or Pacific Islander adults or youth who are pregnant or have been pregnant in the last 12 months

 

Core Services of Enhanced Care Management

Outreach & Engagement

Contact and engage the member in their care.

Comprehensive Assessment and Care Management Plan

Complete a comprehensive assessment with the member and work with them to develop a care plan to manage and guide their care and meet their goals.

Enhanced Coordination of Care

Coordinate care and information across all of the member’s providers and implement the care plan.

Coordination of and Referral to Community and Social Support Services

Connect the member to community and social services.

Member and Family Supports

Educate the member and their personal support system about their health issues and options to improve treatment adherence.

Health Promotion

Provide tools and support that will help the member better monitor and manage their health.

Comprehensive Transitional Care

Help the member safely and easily transition in and out of the hospital or other treatment facilities.

Best Practices & Resources

Explore More

Training & Education

CalAIM Provider Training and Webinars

This resource includes specialized training series on behavioral health, data exchange, care management, justice-involved populations, and youth care.
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