What is Enhanced Care Management?

Enhanced Care Management (ECM) is a personalized program that helps individuals with serious health conditions receive coordinated care at no cost for those with a managed care plan. ECM supports creating care plans, ensures proper treatments, provides health education, and connects individuals with community services. The program works with doctors, health plans, and local organizations to deliver the best care.

Enhanced Care Management Offerings:

Personalized Care Plans: Tailored support for health and well-being
Comprehensive Needs Assessment: Addressing medical and non-medical needs (e.g., housing, transportation)
Chronic Condition Support: Helping manage long-term health conditions
Health Education: Empowering informed health decisions
Resource Assistance: Connecting to community services
Ongoing Support: Continuous care and guidance
Care Team Collaboration: Coordinating with providers and community partners

Who Qualifies for Enhanced Care Management in California:

Individuals with Complex Health Conditions: Managing multiple chronic diseases or significant medical needs
High-Risk Populations: Individuals with mental health, substance use, or developmental disorders
Frequent Healthcare Utilizers: High hospital/emergency visits or healthcare costs
Socially Vulnerable Individuals: Facing homelessness, food insecurity, or lack of transportation
Dual Eligible Individuals: Eligible for both Medi-Cal and Medicare
Medically Complex Populations: Requires intensive, coordinated care across providers and services

Who Qualifies for Enhanced Care Management in California

Population of Focus	Adults	Children and Families
Pregnancy, Postpartum	Yes Eligible
Adults/Children with an Intellectual/Developmental Disability	Yes Eligible	Yes Eligible
Children and Youth Involved in Child Welfare	Yes Eligible
Children and Youth Enrolled in California Children Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS Condition
Adult Nursing Facility Residents Transitioning to the Community	Yes Eligible
Adults Living in the Community and At Risk for Long-Term Care (LTC) Institutionalization	Yes Eligible
Serious Mental Illness (SMI)/Substance abuse disorders	Yes Eligible	Yes Eligible
homeless	Yes Eligible	Yes Eligible
At risk of Avoidable Emergency Department (ED)/Hospital Use	Yes Eligible	Yes Eligible