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• What is Enhanced Care Management?
  • Enhanced Care Managemet (ECM) is a free benefit for eligible Medi-Cal members that gives an extra layer of support to help you get the care you need to thrive.
  • You will be provided with a Lead Care Manager who will work with your doctors, specialists, pharmacists, and others to help get your needs met.
  • Joining ECM is a choice. You can leave the program at any time and keep your Medi-Cal benefits.
  • ECM is provided by Community-Based Organizations that are contracted with the Medi-Cal Managed Care Plans. More information about these providers can be found here.
• Who is eligible for Enhanced Care Management?

  Medi-Cal members, must have active Medi-Cal and an assigned Medi-Cal Managed Care Plan, and meet one or more of the following:

  • Do not have a safe place to live or are experiencing homelessness
  • Visited the emergency room or hospital five or more times (adults) or three or more times (youth 21 years and under) in the last six months
  • Have a mental health, behavioral and/or substance use disorder
  • Are an adult (21 years or older) who is at risk of entering a nursing home or facility
  • Are an adult living in a nursing home or facility, and want to move back to the community
  • Signed up for California Children’s Services program and need more support
  • Have been in foster care (up to 26 years old)
  • Transitioned out of jail, prison, or youth detention facility in the past year and have a health condition
  • Are pregnant or had a baby in the last year and are American Indian, Alaskan Native, Black, or Pacific Islander)

  For more details about who qualifies, please reference the ECM Policy Guide.

• Getting Connected with Enhanced Care Management

  There are several ways to get connected with Enhanced Care Management:

  • Talk to the client's Health Care Provider or call the assigned Medi-Cal Managed Care Plan
    • Interested Medi-Cal members, or those caring for someone on Medi-Cal, can talk to the member's health care provider or call the assigned Medi-Cal Managed Care Plan.
      • Blue Shield Promise: 1-855-699-5557
      • Community Health Group 1-800-224-7766
      • Kaiser Permanente 1-855-839-7613
      • Molina Healthcare 1-888-665-4621
        
        
  • OR, Get Support From Neighborhood Networks
    • Neighborhood Networks, a Community Care Hub, can also help applicants with Enhanced Care Management and the Housing Community Supports, please call (619) 273-3295 or use their Interest Form
      
      
  • OR, Complete and Send a Referral Form

  1. Confirm the applicant has active Medi-Cal and identify the assigned Medi-Cal Managed Care Plan (Blue Shield Promise, Community Health Group, Kaiser Permanente, or Molina Healthcare).
  2. Ensure the individual meets the eligibility criteria for Enhanced Care Management. Additional guidance can be found in the ECM Policy Guide.
  3. Complete the universal or plan specific ECM referral form linked below, and email the form to the assigned Managed Care Plan’s designated email address. The Adult Universal ECM Referral Form / Children/Youth Universal ECM Referral Form is accepted by all plans.
  4. Note that the Managed Care Plan should authorize ECM services within 5 working days for routine authorizations and within 72 hours for expedited requests. If you have not received a response, email or call the Managed Care Plan for an update.

   

  Managed Care Group	Link to Referral Form (Child/Youth)	Link to Referral Form (Adult)	Email	Phone Number
  Blue Shield Promise	ECM Referral Form (Child/Youth)	ECM Referral Form (blueshieldca.com)	ECM@blueshieldca.com	1-855-699-5557
  Community Health Group	ECM Referral Form (Child/Youth)	ECM Referral Form (chgsd.com)	ecm-cs@chgsd.com	1-800-224-7766
  Kaiser Permanente	ECM Referral Form (Child/Youth)	ECM Referral Form (kaiserpermanente.org)	RegCareCoordCaseMgmt@KP.org	1-855-839-7613
  Molina Healthcare	ECM Referral Form (Child/Youth)	ECM Referral Form (molinahealthcare.com)	MHC_ECMReferrals@Molinahealthcare.com	1-888-665-4621

  • More information on ECM providers: 2-1-1 San Diego is the region's trusted source for information and connections to community, health resources, and provider contact information: 211Sandiego.org
• Enhanced Care Management Flyers
  • Enhanced Care Management for Medi-Cal Members (English)
    • Spanish | Arabic | Chinese | Korean | Persian-Farsi | Somali | Tagalog | Vietnamese
    
    
  • For more flyers and links, click here.