What will you gain as a member of ECM?

You will have a personalized care team – including a Lead Care Manager – that works together to help you get the care you need.

Your care team and Lead Care Manager will work with you to develop an individualized Care Management Plan (CMP). A CMP will help you to meet your goals and objectives in hopes of better overall health and wellness. 

You receive extra services at no cost as part of your Medi-Cal benefits, including help with:

• Making and following-through with appointments
• Transportation to-and-from doctors appointments
• Understanding your prescription medications
• Medication reminders
• Remote patient monitoring
• Getting follow-up services after you leave the hospital
• Connecting to and applying for community programs and services, including food benefits and housing

Who qualifies for ECM? 

To be eligible for ECM services, patients must meet the following requirements

• Be enrolled in a Medi-Cal health plan
• Meet criteria for 1 of 4 current Populations of Focus as indicated below:
• 1. Adult Experiencing Homelessness AND  have at least one complex physical, behavioral, or developmental health need 
• 2. Adult High Utilizers who in the last six months have had 5 or more ER visits OR 3 unplanned hospital admissions OR 3 or more short-term SNF stays
• 3. Adult with Serious Mental Illness or Substance Use Disorder and other health needs are individuals who are working with the County Specialty Mental Health (SMH) System or the Drug Medi-Cal Organization Delivery System (DMC-ODS) AND at risk of institutionalization OR experiencing a complex social factor affecting their health
• 4. Individual transitioning from Incarceration within the last 12 months AND have at least one of the following conditions: substance use    disorder, chronic disease, intellectual or developmental disability, traumatic brain injury, HIV/AIDS, or pregnancy

For more general information regarding the Enhanced Care Management Program, please view the Member Toolkit