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CalAIM Enhanced Care Management and Community Supports (care teams, housing help, meals and respite through the Medi-Cal health plan): who qualifies, what you get, how to apply, and what happens next

Enhanced Care Management gives Medi-Cal plan members with highly complex needs their own care team; Community Supports are extra services, such as housing deposits, recuperative care and medically tailored meals, that each plan may offer. Both followed the Whole Person Care pilot under CalAIM. A member gets them by calling the member services number on the Medi-Cal plan card or through a provider referral.

What Enhanced Care Management and Community Supports are, in one paragraph

Enhanced Care Management (ECM) and Community Supports are Medi-Cal benefits under CalAIM, the statewide program that followed Whole Person Care and the Health Homes Program (rule:successor). Both come through the member's Medi-Cal managed care plan, not through a separate application. ECM gives a member with highly complex needs their own care team (rule:ecm_definition, rule:ecm_team). Community Supports are extra services, such as housing deposits, recuperative care and medically tailored meals, that a plan may offer in place of other care (rule:cs_definition). They are optional and do not replace other Medi-Cal benefits (rule:cs_optional).

UNKNOWN
no dollar amount: ECM and Community Supports are services, not cash; no official page read today states a value (Alameda Alliance, rule:ecm_definition)

Who may qualify

A Medi-Cal managed care member who meets at least one Population of Focus can get ECM (rule:ecm_populations):

Population of FocusRule
Adults, families and unaccompanied children or youth experiencing homelessnessrule:pof_homeless
People at risk of avoidable hospital or emergency department userule:pof_utilizers
People with serious mental health or substance use disorder needsrule:pof_smi_sud
Adults in the community at risk for long-term carerule:pof_ltc_risk
Adult nursing facility residents moving to the communityrule:pof_nf_transition
Children and youth in California Children's Services with needs beyond CCSrule:pof_ccs
Birth equity populationrule:pof_birth_equity

Community Supports are offered plan by plan (rule:cs_varies_by_plan). One county plan, Alameda Alliance, lists: housing transition navigation (rule:cs_housing_navigation), housing deposits (rule:cs_housing_deposits), tenancy and sustaining services (rule:cs_tenancy), recuperative care (rule:cs_recuperative), medically tailored meals (rule:cs_meals), asthma remediation (rule:cs_asthma), caregiver respite (rule:cs_respite) and sobering centers (rule:cs_sobering).

How to get it, and what happens after

There is no application form for the person. Call the member services number on the Medi-Cal plan card and ask for Enhanced Care Management or a named Community Support (rule:self_referral). A doctor or other provider can refer you (rule:provider_referral), and the plan may contact you first (rule:plan_outreach). The plan decides.

If the plan says no, appeal to the plan within 60 days of the notice (rule:plan_appeal_60). After the plan's answer, or if it has not answered in 30 days, request a state hearing within 120 days (rule:hearing_after_plan_120, rule:hearing_if_no_answer_30), at (800) 743-8525 (rule:hearing_phone).

The procedure, stage by stage, as data
JSONThe procedure, stage by stage, as data
8 items
10 keys
"id""stage:discover"
"order"1
"name""Discover"
"what_happens""A Medi-Cal plan member, a family member or a provider learns that ECM and Community Supports exist and that they come through the health plan (rule:successor)"
"who_acts""Member / provider"
"timeline""No deadline"
"evidence""Medi-Cal plan card"
"failure_mode""Nobody asks the plan"
"model_role""Ask the referral question for every member who meets a Population of Focus"
"automation_class""D - referral-based; discovery is the product"
10 keys
"id""stage:screen_eligibility"
"order"2
"name""Screen eligibility"
"what_happens""Medi-Cal managed care membership plus at least one Population of Focus for ECM (rule:ecm_populations); Community Supports by need, as the plan offers them (rule:cs_varies_by_plan)"
"who_acts""Model + member"
"timeline""Minutes"
"evidence""Plan name, housing status, hospital use, mental health or SUD needs, care needs"
"failure_mode""Members in a Population of Focus never referred"
"model_role""Match the member to each Population of Focus rule"
"automation_class""A"
10 keys
"id""stage:referral"
"order"3
"name""Submit referral"
"what_happens""Self-referral by calling the plan (rule:self_referral), provider referral (rule:provider_referral), or plan outreach (rule:plan_outreach)"
"who_acts""Member, provider or plan"
"timeline""UNKNOWN: no page read today states a processing time"
"evidence""Referral"
"failure_mode""Not knowing the plan phone number"
"model_role""Give the plan’s member services number from the plan card"
"automation_class""B - a call or a form"
10 keys
"id""stage:decision"
"order"4
"name""Decision"
"what_happens""The plan decides whether to authorize ECM or the Community Support"
"who_acts""Plan"
"timeline""UNKNOWN"
"evidence""Plan notice"
"failure_mode""An unexplained no"
"model_role""Read the notice; check the Population of Focus"
"automation_class""C - plan decision"
10 keys
"id""stage:issuance_use"
"order"5
"name""Issuance / use"
"what_happens""ECM: an assigned care team (rule:ecm_team). Community Supports: the service the plan approved, such as housing deposits, recuperative care or meals"
"who_acts""Plan + providers"
"timeline""UNKNOWN"
"evidence""Care plan"
"failure_mode""Losing contact with the care team after a move"
"model_role""Keep the care team’s contact"
"automation_class""C"
10 keys
"id""stage:renew_recertify"
"order"6
"name""Renew / recertify"
"what_happens""Services continue while the member keeps Medi-Cal and meets the criteria; the Medi-Cal renewal keeps the plan"
"who_acts""Member"
"timeline""With Medi-Cal"
"evidence""Medi-Cal renewal"
"failure_mode""Medi-Cal lost at renewal ends ECM"
"model_role""Track the Medi-Cal renewal month"
"automation_class""B"
10 keys
"id""stage:appeal_fair_hearing"
"order"7
"name""Appeal / fair hearing"
"what_happens""Plan appeal within 60 days (rule:plan_appeal_60); state hearing within 120 days of the plan’s answer (rule:hearing_after_plan_120), or after 30 days with no answer (rule:hearing_if_no_answer_30)"
"who_acts""Member + plan + CDSS State Hearings Division"
"timeline""60 days, then 120 days"
"evidence""Notice of action, Notice of Appeal Resolution"
"failure_mode""Going to a state hearing before the plan appeal"
"model_role""Give the order and the dates"
"automation_class""B"
10 keys
"id""stage:overpayment_exit"
"order"8
"name""Overpayment / exit"
"what_happens""ECM and Community Supports end when the member leaves the plan or Medi-Cal, or no longer meets the criteria"
"who_acts""Plan"
"timeline""At change"
"evidence""Notice"
"failure_mode""Services stop without the member knowing why"
"model_role""Check the notice reason"
"automation_class""C"

The same facts open other programs

Medi-Cal membership, housing status and care needs are the facts this benefit asks. They also open:

References (8)
What this article shares with the graph
JSONWhat this article shares with the graph
6 keys
"program_id""B070"
"graph""california-benefits-graph"
"related_program_ids" 8 items
"B011"
"B074"
"B079"
"B040"
"B015"
"B016"
"B018"
"B073"
"related_programs" 8 keys
"B011""Medi-Cal (Medicaid) (level: Federal/State; administrator: CA Dept of Health Care Services + counties / Covered California; graph url: https://www.dhcs.ca.gov/services/medi-cal)"
"B074""Home-delivered groceries / medically tailored meals (CalAIM Community Support)"
"B079""Continuum of Care shelters + Coordinated Entry"
"B040""CalWORKs Housing Support Program + county rapid rehousing"
"B015""In-Home Supportive Services (IHSS)"
"B016""Multipurpose Senior Services Program (MSSP) + CBAS (level: State; administrator: DHCS / local MSSP sites; graph url: https://www.dhcs.ca.gov/services/medi-cal)"
"B018""California Children's Services (CCS)"
"B073""PACE (Program of All-Inclusive Care for the Elderly) (level: Federal/State; administrator: DHCS / PACE organizations; graph url: https://www.dhcs.ca.gov/services/medi-cal)"
"triggered_by_events" 1 item
"event:became_homeless_no_address_tonight"
"shares_facts_with" 2 keys
"benefits.currently_receiving[]" 4 items
"B001"
"B009"
"B043"
"B047"
"person.identity.date_of_birth" 5 items
"B001"
"B011"
"B013"
"B023"
"B063"

Official addresses

Related pages
Beside
Medi-Cal (California Medicaid health coverage): who qualifies, what you get, how to apply, and what happens nextHome-delivered groceries / medically tailored meals (CalAIM Community Support) (Medi-Cal plan meals and groceries for diet-sensitive health conditions): who qualifies, what you get, how to apply, and what happens nextContinuum of Care shelters and Coordinated Entry (the front door to homeless housing in each county): who qualifies, what you get, how to apply, and what happens nextCalWORKs Housing Support Program and county rapid rehousing (housing help for CalWORKs families): who qualifies, what you get, how to apply, and what happens nextMSSP and CBAS (Medi-Cal care management for seniors and adult day health centers that keep people out of nursing homes): who qualifies, what you get, how to apply, and what happens next
References (29)
  1. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: CalAIM succeeds Whole Person Care — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“builds upon the Whole Person Care (WPC) Pilot and Health Homes Program (HHP)”
  2. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: what ECM is — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Enhanced Care Management (ECM) is a benefit that provides extra care coordination services to members with highly complex needs.”
  3. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: care team — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Members who qualify for ECM will have their own care team”
  4. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: populations of focus — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“ECM will be offered to members who meet at least one of the ECM Populations of Focus definitions described below.”
  5. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: homelessness — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Adults without dependent children/youth living with them experiencing homelessness.”
  6. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: avoidable hospital use — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Individuals at risk for avoidable hospital or emergency department (ED) utilization”
  7. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: mental health and SUD — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Individuals with serious mental health and/or substance use disorder (SUD) needs”
  8. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: risk of long-term care — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Adults living in the community and at risk for long-term care”
  9. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: nursing facility transition — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Adult nursing facility residents transitioning to the community.”
  10. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: children in CCS — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Children and youth enrolled in California’s Children Services (CCS) or CCS Whole Child Model (WCM) with additional needs beyond the CCS”
  11. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: birth equity — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Birth equity population of focus”
  12. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: plan outreach — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“The Alliance may contact the member directly about ECM if the member qualifies.”
  13. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: self-referral — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“The member may also self-refer by calling:”
  14. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: what Community Supports are — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Community Supports (CS) are medically appropriate, cost-effective alternatives to those services covered under the Medi-Cal State Plan.”
  15. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: optional — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“These services are optional and may help members live more independently but do not replace benefits that they already get under Medi-Cal.”
  16. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: what one plan offers — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“The Alliance is currently offering the following CS services:”
  17. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: housing navigation — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Assists members with obtaining housing.”
  18. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: housing deposits — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Assists members with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a member to establish a basic household (that do not constitute room and board).”
  19. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: tenancy — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“with a goal of maintaining safe and stable tenancy once housing is secured”
  20. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: recuperative care — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness”
  21. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: medically tailored meals — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Meals provided/delivered to the home that meet the unique dietary needs of those with chronic conditions, immediately following discharge from a hospital or nursing home.”
  22. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: asthma remediation — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the individual”
  23. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: respite — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Assists members (and their caregivers) by providing relief support to caregivers”
  24. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: sobering centers — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Alternative destinations for members who are found to be publicly intoxicated”
  25. Enhanced Care Management (ECM) and Community Supports (CS) | Alameda Alliance for Health: provider referral — Alameda Alliance for Health (Alameda County public Medi-Cal managed care plan)“Members can be referred for ECM and CS by their provider to:”
  26. Hearing Requests | CDSS: plan appeal — California Department of Social Services, State Hearings Division“You have 60 calendar days from the date of the notice of action to file an appeal with the managed care plan.”
  27. Hearing Requests | CDSS: hearing after plan appeal — California Department of Social Services, State Hearings Division“you have 120 calendar days from the date of the plan’s Notice of Appeal Resolution to request a state hearing.”
  28. Hearing Requests | CDSS: no answer in 30 days — California Department of Social Services, State Hearings Division“You may also request a state hearing if you filed an appeal with the managed care plan and you have not received a Notice of Appeal Resolution within 30 days.”
  29. Hearing Requests | CDSS: phone — California Department of Social Services, State Hearings Division“Call the State Hearings Division toll free (800) 743-8525”