ECM gives qualified members extra services from a dedicated ECM provider, which is an entity that contracts with a Medi-Cal managed care health plan. A lead care manager, who works for the ECM provider, coordinates the member’s health care services and links them to community and social services. The member’s ECM provider works with all of their providers to give an added layer of support. Members get these extra services at no cost as part of their Medi-Cal benefits. ECM will not take away any of the member’s current Medi-Cal benefits.

ECM is intended for the highest risk Medi-Cal members with the most complex medical and social needs, such as a lack of stable housing. ECM will provide these members with long-term help coordinating their services across delivery systems to address their needs. To be eligible for ECM, members must be enrolled in a Medi-Cal health plan and meet certain criteria.

If members qualify, it is their choice whether they would like to receive the ECM benefit or not.

1. Outreach and Engagement
2. Comprehensive Assessment and Care Management Planning
3. Enhanced Coordination of Care
4. Health Promotion
5. Comprehensive Transitional Care
6. Member and Family Supports
7. Coordination of and Referral to Community and Social Support Services

ECM is delivered primarily by community-based entities that hold contracts with Medi-Cal health plans. Examples of entities that might deliver ECM include Federally Qualified Health Centers (FQHCs) and other community clinics, county and social service agencies, and other community-based entities. The Medi-Cal health plan assigns each member to an ECM provider, which will include a lead care manager. The lead care manager serves as the member’s primary point of contact and works with all their providers – such as doctors, specialists, pharmacists, social service providers, and others – to make sure everyone is in agreement about the member’s needs and care.

1. Members who qualify may be contacted directly by their Medi-Cal health plan and/or an ECM provider.
2. A health or social services provider, including an ECM or Community Supports provider, may submit a referral for a member. If they are eligible, the Medi-Cal health plan will assign them an ECM provider.
3. A member or a member’s family member may contact their health plan to see if they qualify. Members can contact their Medi-Cal health plan by calling the number on the back of their insurance card. If they are eligible, the health plan will assign them an ECM provider.

In some cases, ECM provides services that are different from the services they receive in other state programs. In these cases, a member can receive services from both programs simultaneously. In other cases, the state program may provide services similar to ECM. In these cases, they would not be eligible for ECM unless they discontinued from the similar service.

ECM is intended for the highest risk, highest-cost Medi-Cal managed care members with the most complex medical and social needs. ECM will provide these members with long-term help coordinating their services across delivery systems to address their needs. To be eligible for ECM, members must be enrolled in a Medi-Cal managed care health plan and meet criteria for at least one of the Populations of Focus. California’s Department of Health Care Services (DHCS) has identified both adult and children/youth Populations of Focus for ECM.

1. Members who qualify may be contacted directly by their health plan and/or an ECM provider.
   Medi-Cal health plans are responsible for regularly identifying members who may benefit from ECM and who meet the criteria for the program. Once a member is identified, the health plan and/or their assigned ECM provider will contact them to discuss ECM.
2. A health and social services provider, including an ECM or Community Supports provider, may submit a referral for members.
   If a member has not been identified by the Medi-Cal health plan as eligible for ECM, but meets the requirements, their provider can submit a referral to the member’s health plan. The health plan is required to have a referral process that is available for health and social service providers. You do not need to be a clinician to refer someone to ECM.
3. Members may self-refer or ask for information to see if they qualify.
   A member or the member’s family can contact their Medi-Cal health plan to see if they qualify for ECM. Members can contact their health plan by calling the number on the back of their insurance card.

In most cases, Medi-Cal health plans will determine a member is qualified to receive ECM and assign an ECM provider that will then reach out to the member to see if they would like to receive the benefit. If the member agrees to receive the benefit, the ECM provider will begin services. A member is not required to receive the ECM benefit, even if they qualify.

Medi-Cal health plans will assign an ECM provider to a member based on their needs. If a member’s primary care provider or behavioral health provider is affiliated with an ECM provider organization, the member will most likely be assigned to that ECM provider. If one of the member’s primary providers is not part of an ECM provider organization, the assigned ECM provider must coordinate with the member’s existing providers. A member can also choose a different ECM provider if they want.

ECM services are primarily delivered in person where members live or receive care but can be delivered at any location they prefer. ECM services may also be delivered through other communication methods (e.g., phone or video visit) that work best for or are preferred by members. Services must be culturally and linguistically appropriate.

ECM coordinates transportation but does not provide actual transportation to services.

Under Medi-Cal, health plans are responsible for providing transportation to all medically necessary services. ECM can support members in accessing, scheduling, and coordinating these services.

Each member’s ECM provider, including their lead care manager, will work with them and their providers to develop a comprehensive care plan to guide their services and care. The member will be a partner in developing the care plan. The care plan is based on the member’s goals, health status, needs, and preferences regarding:

• Physical health
• Mental health
• Disabilities
• Substance use
• Oral health
• Community-based long-term services and supports Supports to manage serious illness (e.g., palliative care)
• Trauma-informed care needs
• Community and social services

Each member has an ECM provider that coordinates a multi-disciplinary care team which includes the member’s other health care providers and community and family or personal support networks if they wish. Their ECM provider will also assign a lead care manager, who will be the member’s primary point of contact.  The lead care manager works with the member to create a care plan, coordinate their care, and make sure they receive all needed services. Other providers also help develop and implement the care plan as appropriate.

ECM is delivered primarily by community-based entities, serving as ECM providers, that hold contracts with Medi-Cal health plans. If a member’s primary care provider is affiliated with an ECM provider organization, the member will be assigned to that ECM provider unless they choose a different one. If a member’s primary care provider is not part of the ECM provider organization, the lead care manager must coordinate with the members primary care provider.