CalAIM: Enhanced Care Management and Community Supports Services

Enhanced Care Management (ECM)

ECM is a new program that helps our Members with complex medical and social needs. These new services offer help beyond traditional medical services.  These services are provided to eligible adults, children, pregnant and/or postpartum women and justice involved individuals.

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 

ECM allows Members to have their own care team, including a Lead Care Manager (LCM) from a PCP office or a community based organization. This person will talk to Members and their doctors, specialists, pharmacists, case managers, social services providers and others to make sure everyone works together to get them the care they need. The LCM can also help Members find and apply for other services in their community.  

ECM services include:

1. Outreach and Engagement
2. Comprehensive Assessment and Care Management Plan
3. Enhanced Coordination of Care
4. Health Promotion
5. Comprehensive Transitional Care
6. Member and Family Supports
7. Coordination of and Referral to Community and Social Support Services

How to Access ECM Services

Members are encouraged to speak with their medical providers about this benefit. To be eligible for ECM, Members must meet at least one of the populations of focus. Providers can submit a referral to ECM using this ECM Referral Form.

• To understand the process of reviewing requests by CHG HealthCare Services: Review Process for Requested Services
• For more information on ECM, please visit the DHCS website using this link: https://www.dhcs.ca.gov/Pages/ECMandILOS.aspx
• To review the ECM Member Toolkit, please visit the DHCS website using this link: https://www.aurrerahealth.com/wp-content/uploads/2022/01/ECM-Member-Toolkit_FINAL.pdf
• To review the ECM Providers and the Populations of Focus they serve, use this link: Population of Focus by ECM Provider

Community Supports (CS)

Community Supports are optional services for Medi-Cal Members that may not include direct medical care. These services are free of charge and help members with complex health issues. These health issues are often caused or made worse by lack of food, housing, or transportation.

CS services include:

1. Housing Transition Navigation Services
2. Housing Deposits
3. Housing Tenancy and Sustaining Services
4. Short-Term Post Hospitalization Housing
5. Recuperative Care (Medical Respite)
6. Respite Services
7. Day Habilitation Programs
8. Nursing Facility Transition/Diversion to Assisted Living Facilities
9. Community Transition Services/ Nursing Facility Transition to a Home
10. Personal Care and Homemaker Services
11. Environmental Accessibility Adaptations (Home Modifications)
12. Medically Tailored Meals
13. Sobering Centers
14. Asthma Remediation

How to Access CS Services

Members are encouraged to speak with their ECM provider, medical providers or social service providers about this benefit. To be eligible for CS, Members must meet the criteria outlined in the CS referral form. Providers can submit a referral to CS using this CS Referral Form.

• To understand the process of reviewing requests by CHG HealthCare Services: Review Process for Requested Services
• For more information on CS, please visit the DHCS website using this link: https://www.dhcs.ca.gov/Pages/ECMandILOS.aspx
• To review the Community Supports Explainer, please visit the DHCS website using this link: https://www.aurrerahealth.com/wp-content/uploads/2021/12/Community-Supports-Explainer_FINAL.pdf