Enhanced Care Management
Eligible Medi-Cal members have a new benefit called Enhanced Care Management.
Enhanced Care Management is for members who have:
- Chronic health issues
- Social needs
- Been to the Emergency Room more than others
- Been admitted to the hospital more than others
Enhanced Care Management can help with things that impact your health, such as:
- Lack of a ride
- Questions about your medication
- Connecting to community care that might help you and your support system
- Finding doctors and making appointments
- Keeping all your doctors updated about your health needs and wishes
- Understanding your medications and getting refills
- Connecting you to community and social services that you need (like food and in-home support)
- If you are an adult and do not currently have stable housing
- If you are an adult and have difficult health issues and you have needed to go to the hospital or emergency department many times over the last six months
- If you are an adult and have a serious mental health condition or struggle with drug or alcohol use
Enhanced Care Management also makes sure that your providers have the most recent information about you. If you want to learn if you can get free Enhanced Care Management, please call SFHP Care Management Intake line at 1(415) 615-4515.
Frequently Asked Questions (FAQs)
For Members Interested in Enhanced Care Management Services (ECM)
Enhanced Care Management (ECM) is a new Medi-Cal benefit that offers extra care management services at no cost to qualifying members who have complex needs and challenges that make it difficult to improve their health.
If you qualify, ECM provides coordination services, including a dedicated care manager who will work with you to help you, your family members, legal guardians, authorized representatives, caregivers, and other authorized support persons, as appropriate, get the care you need. Your care manager works with you to develop a care plan, coordinates with your current providers, and offers an added layer of support, including help with things like:
To qualify for ECM, you must (1) be enrolled in a Medi-Cal health plan and (2) meet certain eligibility requirements.
ECM will be offered to members at different times starting on January 1, 2022. If any of the below apply to you, you may be eligible for ECM.
To learn more about ECM and Community Supports and determine if you are eligible, you can talk to your doctor or Medi-Cal health plan.
Your doctor or Medi-Cal health plan may also contact you directly if they determine you may be eligible.
The Medi-Cal services you get now will not change or be taken away and you can still see your same doctors.
If you qualify for ECM, receiving those services is your choice.
You must be enrolled in a Medi-Cal health plan to access ECM services. If you need help enrolling in a Medi-Cal health plan, you can call Health Care Options at 1(800) 430-4263 (TTY 1-800-430-7077) or by going to www.healthcareoptions.dhcs.ca.gov.
ECM is provided at no cost to you as part of your Medi-Cal benefits.
If you enroll in ECM, you can continue to see the same doctors. ECM offers an added layer of support and coordination with your existing doctors and service providers.
ECM will be available for certain populations starting January 1, 2022. Additional populations will become eligible over time. To determine if you are eligible, you can talk to your doctor or Medi-Cal health plan. To find the phone number for your Medi-Cal health plan, check your Medi-Cal ID Card or go to bit.ly/plandirectory and click on your county.
Your doctor or Medi-Cal health plan may also contact you directly if they determine you may be eligible.
To learn more about ECM, you can talk to your doctor or Medi-Cal health plan. You can call SFHP at 1(800) 288-5555 or TTY 1(888) 883-7347.