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Enhanced Care Management (ECM)

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

The Enhanced Care Management (ECM) benefit is a statewide benefit established by the Department of Health Care Services (DHCS) to provide a whole-person approach to care that addresses the clinical and non-clinical circumstances of high-need Medi-Cal beneficiaries enrolled in Medi-Cal managed care. ECM providers are community-based entities with experience and expertise in providing intensive, in-person care coordination and care management services to individuals in one or more of the Populations of Focus and often employ those with lived experience in these populations. ECM will be offered primarily through in-person interaction where members and their families and support networks live, seek care, and prefer to access services. The goal of the ECM benefit is to improve the health and social outcomes of the member. The following are seven core ECM services available to enrolled members:

  1. Outreach and engagement.
  2. Comprehensive assessment and care management plan.
  3. Enhanced care coordination.
  4. Health promotion.
  5. Comprehensive transitional care.
  6. Member and family supports.
  7. Coordination of and referral to community and social support services.
Refer to the DHCS ECM Provider Toolkit (PDF) to learn more about the seven core areas.

Eligibility Criteria

To be eligible for the ECM benefit, members must qualify for one or more of the identified ECM Populations of Focus and are not enrolled in duplicative services.

ECM Population of Focus
Eligibility Criteria

1. Homeless Families or Individuals Experiencing Homelessness

  • Have significant health needs.
  • Are experiencing homelessness such as:
    • Loss of housing
    • Living in motels, hotels or shelters
    • Having financial difficulties
  • Are at-risk of becoming homeless.

2. Individuals at Risk for Avoidable Hospital or Emergency Department (ED) Utilization
  • Frequent visits to the emergency room.
  • Experience unplanned stays at hospitals or short-term nursing facilities.
3. Individuals with Serious Mental Health and/or Substance Use Disorder (SUD) Needs
  • Getting services for mental health and substance use.
  • Experiencing social issues impacting their health, such as poverty, homelessness, access to health care, etc.
  • Frequently uses crisis services, ERs, urgent care and inpatient stays.
4. Individuals Transitioning from Incarceration Within the Past 12 Months
  • Recently released from incarceration or a correctional setting.
  • Have at least one health condition such as:
    • Mental illness
    • Substance use disorder
    • Chronic condition
    • Intellectual or developmental disability (I/DD)
    • Traumatic brain injury (TBI)
    • HIV/AIDS
    • Pregnant or postpartum
5. Adults Living in the Community Who Are at Risk for LTC Institutionalization
  • Need skilled nursing care but can live in the community.
  • Able to live independently with support services.
  • Experience one complex social or environmental factor.
6. Adult Nursing Facility Residents Transitioning to the Community
  • Want to move out of institutional care.
  • Can live safely and independently in the community.
7. Children/Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) With Additional Needs Beyond the CCS Condition
  • Enrolled in CCS or CCS WCM; AND
  • Experience one social issue impacting their health such as:
    • Food insecurity
    • Housing instability or at-risk for homelessness
    • History of ACEs, trauma and contacts with law enforcement.
8. Children/Youth Involved in Child Welfare
  • Currently or recently in foster care, adoption, or family maintenance programs
9. Birth Equity Adults and Youth
  • Are pregnant or in postpartum.
  • Experiencing disparities in healthcare based on race or ethnicity.

For additional information on the Population of Focus or eligibility criteria, refer to the DHCS ECM Policy Guide (PDF) or the Plan’s ECM Provider Guide below:

Referrals to ECM Service

Before making a referral, verify the member’s eligibility with the Plan by checking the provider portal. Once determined that the member is eligible, use the appropriate method to make ECM referrals via the provider portal, findhelp, or provider services.

1. Provider Portal, Log in to the secure provider portal

  • Select Authorization from the top toolbar.
  • Complete sections 1-3 on the right panel:
    • Provider Request
    • Service Line
    • Finish Up (auto populates the member’s information)
  • Click submit – you will receive a confirmation code

2. Findhelp (Non-contracted providers, members and community referrals)

  • Go to findhelp (Health Net and Community Health Plan of Imperial Valley) or findhelp (CalViva Health) to identify local resources
    • Log in/or create an account on findhelp
    • Select the ECM referral button on the homepage
    • Complete the referral and screener form

3. Member Services (Anyone can make a referral)

4. Provider Directory (Anyone can make a referral)

5. Fax ECM referrals (Anyone can make a referral)

Submit a referral with the member’s information that supports their ECM eligibility via fax to 800-743-1655. You can use the ECM referral form on the CalAIM Resources for Providers webpage, but it is not a requirement.

To learn more about ECM and its in-depth workflow, Go to the CalAIM Resources for Providers webpage.

For member resources, go to the following:

Last Updated: 04/15/2025