Enhanced Care Management (ECM)
& Community Supports
Enhanced Care Management (ECM)
Medi-Cal members typically have several complex health conditions involving physical, behavioral, and social needs.
Members with complex needs must often engage several delivery systems to access care, including primary and specialty care, dental, mental health, substance use disorder treatment, and long-term services and supports.
More than half of Medi-Cal spending is attributed to the 5 percent of members with the highest-cost needs.
Enhanced Care Management (ECM) is a statewide Medi-Cal benefit available to select members with complex needs. Enrolled members receive comprehensive care management from a single lead care manager who coordinates all their health and health-related care, including physical, mental, and dental care, and social services. ECM makes it easier for members to get the right care at the right time in the right setting, and receive comprehensive care that goes beyond the doctor’s office or hospital.
Learn more about PHC California offered Enhanced Care Management (ECM):
ECM addresses the clinical and non-clinical needs of the highest-need Medi-Cal members by building trusting relationships with members and providing intensive coordination of health and health-related services. Through ECM, members can also be connected to Community Supports services to help address their health-related social needs, such as access to healthy foods or safe housing to help with recovery from an illness. ECM is available to PHC California members in the following specific groups (called “Populations of Focus”):
• Adults experiencing homelessness
• Adults who are at risk for avoidable hospital or emergency department care
• Adults with serious mental health and/or substance use disorder needs
• Adults living in the community and at risk for long-term care institutionalization
• Adult nursing facility residents transitioning to the community
• Adults transitioning from incarceration
• Pregnant and postpartum individuals; birth equity population of focus
How to Refer a Patient For Enhanced Care Management
There is no cost to the member for ECM services. PHC California’s ECM team contacts members who qualify for ECM services to get consent to receive services. Members must opt-in to receive ECM services.
If you have a patient you want to refer for possible ECM services, please contact PHC California’s Utilization and Case Management department at (800) 474-1434, Monday through Friday, 8:30 a.m. to 5:30 p.m. or fax (888) 238-7463.
Community Supports
Community Supports are services provided by PHC California to address members’ health-related social needs, help them live healthier lives, and avoid higher, costlier levels of care. Members may receive a Community Supports service if they meet the eligibility criteria, and if PHC California determines the Community Supports service is a medically appropriate and cost-effective alternative to services covered under the California Medicaid State Plan.
PHC California offers the following Community Supports:
Community transition services/nursing facility transition to home helps 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 helps 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.
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.
Housing deposits helps 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 tenancy and sustaining services helps formerly homeless members maintain safe and stable tenancy once housing is secured.
Housing Transition Navigation Services help members find housing by:
• Conducting a tenant screening and housing assessment
• Developing an individualized housing support plan
• Searching for housing and presenting options
• Assisting in securing housing, including housing applications and required documentation
• Assisting with benefits advocacy
• Identifying and securing available resources to assist with subsidizing rent and covering expenses such as security deposit, moving costs, and other one-time expenses
• Assisting with requests for reasonable accommodation
• Landlord education and engagement
• Ensuring a safe and ready for move-in living environment
• Communicating and advocating on behalf of the Member with landlords
• Assisting in arranging for and supporting the details of the move
• Establishing procedures and contacts to retain housing
• Supporting non-emergency, non-medical transportation to ensure access to housing options
• Identifying, coordinating, securing, or funding environmental modifications to install necessary accommodations for accessibility
Nursing facility transition/diversion to an assisted-living facility helps 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.
How to Refer a Patient for Community Supports
There is no cost to the member for Community Supports services. Members must opt-in to receive Community Supports.
If you have a patient you want to refer for possible Community Supports services, please contact PHC California’s Utilization and Case Management department at (800) 474-1434, Monday through Friday, 8:30 a.m. to 5:30 p.m. or fax (888) 238-7463.