Enhanced Care Management (ECM): who qualifies and how to get it

Enhanced Care Management is the CalAIM benefit that assigns a single care manager to Medi-Cal members with the most complex needs. That person coordinates doctors, behavioral health, housing, food and benefits, and is supposed to meet you where you are — including on the street or in a shelter.

The populations of focus

• Adults and children experiencing homelessness or housing instability.
• Adults and children who are high utilizers of emergency departments or inpatient care.
• Adults and children with serious mental illness or substance use disorder needs.
• Adults living in the community who are at risk of institutionalization.
• Adults in nursing facilities who could transition to the community.
• Adults and youth transitioning out of incarceration.
• Children and youth with complex needs, including those involved in child welfare.
• Pregnant and postpartum individuals subject to birth equity risk factors.

What an ECM care manager actually does

• Builds one care plan instead of five disconnected ones.
• Coordinates between physical health, behavioral health and social services.
• Accompanies members to appointments or arranges transportation.
• Refers into Community Supports such as housing navigation or medically tailored meals.
• Follows up after hospital discharge, which is when most cases fall apart.

How to get referred

1. 01Call your Medi-Cal managed care plan's member services line and ask to be screened for Enhanced Care Management.
2. 02Describe the pattern, not just the diagnosis: how many ER visits, whether housing is stable, whether medications are being missed.
3. 03A clinic, hospital discharge planner, county behavioral health team, probation or a community organization can also submit a referral.
4. 04Ask for the name and phone number of the ECM provider assigned to you.
5. 05If you are declined, ask for the reason in writing and ask what would make you eligible. Circumstances change and you can be re-screened.

If the system stalls

Two things reliably help. First, one document: a short written timeline of hospital visits, housing changes and missed care. Second, one advocate who calls with you rather than for you. Community health workers exist because that combination is what moves cases.