Enhanced Care Management

Enhanced Care Management (ECM) is a new statewide Medi-Cal benefit available to select “Populations of Focus” that will address clinical and non-clinical needs of the highest-need enrollees through intensive coordination of health and health-related services. It will meet beneficiaries wherever they are – at home, in their doctor’s office, in a shelter, or on the street.

Clients who enroll in ECM will have a single Lead Care Manager who will coordinate care and services among the physical, behavioral, dental, developmental, and social services delivery systems, making it easier for them to get the right care at the right time.

Eligibility Providers Connect to ECM

Learn More

Download CalAIM Provider Matrix

Download CalAIM Provider Contact Sheet

Who is Eligible?

The following populations of focus are currently eligible for Enhanced Care Management:

Adults and their Families Experiencing Homelessness

Adults At Risk for Avoidable Hospital or Emergency Department (ED) Utilization (formerly “High Utilizers”)

Adults with Serious Mental Health and/or Substance Use Disorder (SUD) Needs

Individuals Transitioning from Incarceration

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

Adult Nursing Facility Residents Transitioning to the Community

On July 1, 2023, Children and Youth became eligible to receive Enhanced Care Management if they meet any of the following criteria:

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

Children and Youth with Intellectual or Developmental Disabilities (I/DD)

Pregnant or Postpartum Youth

Upcoming Populations of Focus becoming eligible on January 1, 2024:

Adults Transitioning from Incarceration

Children and Youth Transitioning from Incarceration

Adults and youth who are pregnant or postpartum (through 12 months) AND are subject to racial and ethnic disparities as defined by California public health data on maternal morbidity and mortality.

Do you want to find out if you’re eligible? Call 2-1-1 to Learn More!

For more information about the DHCS defined Populations of Focus along with eligibility details, please review: https://www.dhcs.ca.gov/CalAIM/ECM/Documents/ECM-Policy-Guide.pdf