Benefits and Covered Services

Enhanced Care Management (ECM) is a new Medi-Cal benefit that offers extra care management services at no cost to members who have complex needs and who want help to improve their health.

If you qualify, ECM provides care coordination services. ECM provides care coordination services along with access to a care manager who will help you and your support system get the care you need. Your care manager works with you to set up a care plan, coordinates with your providers, and offers extra support. Your care manager can help with things like:

• Helping you to reach your health goals
• Finding providers and making appointments
• Keeping all your providers 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)

To get ECM, you must (1) be enrolled in a Medi-Cal health plan and (2) meet certain eligibility requirements.
If any of the below apply to you, you may be able to get ECM. Children, youth, and adults can get ECM.

• If you are an adult, child/youth, or family and do not have stable housing right now
• 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 6 months
• If you are a child/youth and have difficult health issues and you have needed to go to the hospital or emergency department many times over the last 12 months
• If you are an adult or child/youth and have a serious mental health condition or struggle with drug or alcohol use
• If you are an adult living in the community who might need long-term care
• If you are an adult living in a nursing home and want to live in the community
• If you are a child/youth with complex needs
• If you are a child/youth who has been in the foster system
• Have any of these needs and were diagnosed with an intellectual or developmental disability
• Have any of these needs and who are pregnant or postpartum

To learn more about ECM and check if you are eligible, you can talk to your primary care provider* (PCP) or Medi-Cal health plan.
Your PCP or Medi-Cal health plan may also call you if they think you may be eligible.

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. You can still see the same providers.

If you qualify for ECM, getting those services is your choice.

You must be enrolled in a Medi-Cal health plan to get ECM services. If you need help enrolling in a Medi-Cal health plan, you can call Health Care Options at 1(800) 430-4263 or TTY 1(800) 430-7077. Visit www.healthcareoptions.dhcs.ca.gov for more information.

You can get ECM at no cost as part of your Medi-Cal benefits.

If you enroll in ECM, you can keep seeing the same providers. ECM offers extra support and coordination with your current doctors and service providers.

As of January 1, 2022, qualifying members were eligible to receive ECM services. In January 2024, more people will be able to qualify for ECM. To check if you are eligible, you can talk to your PCP or Medi-Cal health plan. To find the phone number for your Medi-Cal health plan, check your Medi-Cal ID Card or visit CA.gov and click on your county.

Your PCP or Medi-Cal health plan may also call you if they see you may be eligible.

To learn more about ECM, you can talk to your PCP or Medi-Cal health plan. You can call SFHP at 1(800) 288-5555 or TTY 1(888) 883-7347.
*Your primary care provider (PCP) is the doctor, physician assistant, or nurse practitioner in charge of your health care.