Addressing MEDI-CAL ENHANCED CARE MANAGEMENT (ECM)
Today’s newsletter describes California’s new Medi-Cal Enhanced Care Management program, a resource for obtaining Community Supports that can assist individuals in overcoming a variety of life challenges that contribute to worsening of healthcare problems.
THE ISSUE: Medi-Cal members with unmet social needs are at higher risk of poor health outcomes and higher costs for services. The ECM component of Medi-Cal is a new operational responsibility of California Medi-Cal Health Plans.
They are charged with providing ‘medically appropriate’ Community Supports to help members address health-impacting social needs, such housing availability, food insecurity, transportation needs, access to services and a variety of other supports.
These services are accessible for patients enrolled in the ECM program but also may be accessible to individuals with less complex conditions and needs. (See enrollment process information below.)
SERVICES AVAILABLE: Community Supports accessible to patients include referrals and support in obtaining:
» Housing Transition
» Navigation Services
» Housing Deposits
» Housing Tenancy and Sustaining Services
» Short-Term Post-Hospitalization Housing
» Recuperative Care (Medical Respite)
» Caregiver Respite Services
» Personal Care and Homemaker Services
» Nursing Facility Transition/Diversion to Assisted Living Facilities
» Community Transition Services/ Nursing Facility Transition to a Home
» Environmental Accessibility Adaptations (Home Modifications)
» Medically Tailored Meals/ Medically-Supportive Food
» Sobering Centers
» Asthma Remediation
Populations eligible for ECM:
» Adults, unaccompanied youth and children, and families experiencing homelessness.
» Adults, youth, and children who are at risk for avoidable hospital or emergency department care.
» Adults, youth, and children 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.
» Children and youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model with additional needs beyond their CCS condition(s).
» Children and youth involved in child welfare (foster care).
» Adults and youth who are transitioning from incarceration.
» Pregnant and postpartum individuals (starting in 2024).
How it Works:
ECM staff are charged with addressing both the clinical healthcare and the general life needs of vulnerable Medi-Cal members proactively and with appropriate intensity and coordination through referrals to Community Supports to facilitate lower morbidity and complications from health conditions.
The Enhanced Care Management (ECM) program provides:
– Access to a Lead Care Manager who can provide and coordinate referrals for healthcare and health-related supports.
– Referral connections may include referrals to health care providers and promoting access to other relevant community resources.
APPLICATION FOR SERVICES: Primary Care Providers can identify patients meeting program criteria, and inform them of the services available, and encourage them to contact their Medi-Cal plan using the Customer Service number on the back of their cards to request Enhanced Care Management and/or specific Community Supports.
REFERENCES:
DHCS Enhanced Care Management
CA Department of Health Services