Enhanced Care Management (ECM)
& Community Supports
Enhanced Care Management (ECM)
PHC California covers Enhanced Care Management (ECM) services for members with highly complex needs. ECM provides extra services to help you get the care you need to stay healthy. ECM coordinates primary and preventive care, acute care, behavioral health, developmental, oral health, community-based long-term services and supports (LTSS), and referrals to available community resources.
Learn more about PHC California offered Enhanced Care Management (ECM):
If you qualify for ECM, you will have your own care team, including a Lead Care Manager. This person will talk to you and your doctors, specialists, pharmacists, case managers, social services providers, and others to make sure everyone works together to get you the care you need. A Lead Care Manager can also help you find and apply for other services in your community.
ECM includes:
• Outreach and engagement
• Comprehensive assessment and care management
• Enhanced coordination of care
• Health promotion
• Comprehensive transitional care
• Member and family support services
• Coordination and referral to community and social supports
Cost to Member
There is no cost to the member for ECM services. PHC California’s ECM team contact members who qualify for ECM services to get consent to receive services. Members must opt-in to receive ECM services.
Members can stop ECM services whenever they want. They can also ask for a new ECM care coordinator by calling Member Services. The health plan must get permission before sharing a member’s information with anyone outside the plan.
Community Supports
Community Supports are optional, medically appropriate and cost-effective alternative services or settings to those covered under the Medi-Cal State Plan. If you qualify, these services might help you live more independently. They do not replace benefits you already get under Medi-Cal.
PHC California offers the following Community Supports:
Community transition services/nursing facility transition to a home help members live in the community at home and avoid further institutionalization. This Community Support includes set up expenses for a basic household and any needed home modifications or medically-necessary services or items.
Environment accessibility adaptations (EAA) are home modifications to ensure a member’s health, welfare and safety. EAA help a member function independently in the home and avoid being institutionalized. Examples of EAA are ramps, grab-bars, doorway widening for members who require a wheelchair, stair lifts, etc.
Housing deposits help members who are homeless or at risk of becoming homeless set up a basic household by paying for items such as security deposits, first and last months’ rent, set up/deposit fees for utilities, and other services.
Housing transition navigation services help members who are homeless or at risk of becoming homeless find housing.
Housing tenancy and sustaining services help formerly homeless members maintain safe and stable tenancy once housing is secured.
Meals and medically-tailored meals for members who are homebound and not able to grocery shop and/or prepare nutritious meals for themselves. This includes members who have been discharged from hospital or skilled nursing facility and members who have a chronic health condition.
Nursing facility transition/diversion to an assisted-living facility help members move from a nursing facility into an assisted-living facility. This Community Support also prevents a nursing facility admission in favor of moving to an assisted-living facility for members who otherwise would be admitted into a nursing facility. This Community Support will become available July 1, 2024.
Personal care and homemaker services for members who are not able to bathe, groom and/or dress themselves or perform basic housework.
Recuperative Care, also referred to as medical respite care, is short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment. An extended stay in a recovery care setting allows individuals to continue their recovery and receive post-discharge treatment while obtaining access to primary care, behavioral health services, case management and other supportive social services, such as transportation, food, and housing.
If you need help or want to find out what Community Supports might be available for you, call 1-800-263-0067 (TTY 711). Or call your health care provider.
DHCS MMDDYY PHC FR Form 1.0