San Diego Advancing and Innovating Medi-Cal (SDAIM)

Enhanced Care Management and Community Supports 


Enhanced Care Management (ECM) is available for select Medi-Cal members with complex needs. Enrolled members receive comprehensive case management from a lead care manager who coordinates health and social services.

To connect an individual to ECM:

  1. Confirm the individual has active Medi-Cal and identify their Managed Care Plan (MCP).
  2. Ensure the individual meets the eligibility criteria for ECM in the ECM Policy Guide.
  3. Complete the universal or plan specific ECM referral form linked below and email the form to the assigned MCP’s designated email address. The Universal ECM Referral Form is accepted by all plans.

Note that the MCP 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 MCP for an update.

MCPs Link to Referral Form Email Address Member Services Phone Number

Blue Shield Promise 

ECM Referral Form (blueshieldca.com)

Email: ECM@blueshieldca.com

1-855-699-5557

Community Health Group

ECM Referral Form (chgsd.com)

Email: ecm-cs@chgsd.com

1-800-224-7766

Kaiser Permanente

ECM Referral Form (kaiserpermanente.org)

Email: RegCareCoordCaseMgmt@KP.org

1-800-464-4000

Molina

ECM Referral Form (molinahealthcare.com)

Email: MHC_ECMReferral@Molinahealthcare.com

1-888-665-4621

Community Supports are medically appropriate and cost-effective services provided by MCPs to help members address their health-related social needs.

The 14 services are: 

  1. Housing Transition Navigation Services
  2. Housing Deposits
  3. Housing Tenancy and Sustaining Services
  4. Short-Term Post-Hospitalization Housing
  5. Recuperative Care (Medical Respite)
  6. Day Habilitation Programs
  7. Caregiver Respite Services
  8. Personal Care and Homemaker Services
  9. Nursing Facility Transition/Diversion to Assisted Living Facilities

10. Community Transition Services/Nursing Facility            Transition to a Home
11. Environmental Accessibility Adaptations (Home            Modifications)
12. Medically Tailored Meals/Medically-Supportive              Food
13. Sobering Centers
14. Asthma Remediation

Community Supports are available to a wide range of members, including those with complex needs and those who are enrolled in ECM. However, members do not need to be enrolled in ECM to access Community Supports.

To connect an individual to Community Supports:

  1. Confirm the individual has active Medi-Cal and identify their Managed Care Plan (MCP).
  2. Ensure the individual meets the eligibility criteria for Community Supports in the Community Supports Policy Guide.
  3. Complete the plan specific Community Supports referral form linked below for each service needed and email the form(s) to the assigned MCP’s designated email address.
MCPs Link to Referral Form Email Address Member Services Phone Number

Blue Shield Promise 

Community Supports Referral Form (blueshieldca.com)

Email:
SDCommunitySupports@blueshieldca.com

1-855-699-5557

Community Health Group

Community Supports Referral Form (chgsd.com)

Email: ecm-cs@chgsd.com

1-800-224-7766

Kaiser Permanente

Community Supports Referral Form (kaiserpermanente.org)

Email: RegCareCoordCaseMgmt@KP.org

1-800-464-4000

Molina

Community Supports Referral Forms (molinahealthcare.com)

Email: MHC_CS@MolinaHealthcare.com

1-888-665-4621

SDAIM Updates


About SDAIM

San Diego Advancing and Innovating Medi-Cal (SDAIM) refers to the County of San Diego Health and Human Services Agency’s local approach to the Department of Health Care Services’ California Advancing and Innovating Medi-Cal (CalAIM) initiative. SDAIM partners and collaborates with County departments, managed care plans, health and social care providers, community organizations, consumers, and advocates to support CalAIM implementation in San Diego County.

Public Participation

  • October 2023: Live Well Advance Pre-Conference

    The SDAIM team presented an overview of the California Advancing and Innovating Medi-Cal (CalAIM) program which focused on the new services that are available for Medi-Cal members and how to access them, as well as local CalAIM implementation and how you can get involved.
     o   Video Recording
     o   Presentation Slides
 
  • February 2023: Community Listening Sessions
The County of San Diego’s Health and Human Services Agency held two virtual community listening sessions during February 2023 to discuss new services for Medi-Cal members with complex needs and receive input to help create the County's "Roadmap" for California Advancing and Innovating Medi-Cal (CalAIM). Each session provided an overview of CalAIM and presented draft priorities areas and potential strategies for implementation. Public input was solicited through interactive poll questions and discussion forum. 

     o   Video Recording
     o   Presentation Slides
     o   Question and Answer

SDAIM Roadmap

The SDAIM Roadmap was developed based on stakeholder input and outlines the County’s roles, priority areas, data and evaluation priorities, and initial implementation steps.

Email SDAIM.HHSA@sdcounty.ca.gov with questions or feedback.

Board of Supervisors Actions

May 23, 2023: Receive the San Diego Advancing and Innovating Medi-Cal Roadmap and Authorize an Intergovernmental Transfer Agreement for Behavioral Health Services

Upcoming Events


As the selected facilitator for your San Diego County PATH CPI Collaborative, Intrepid Ascent is responsible for hosting and facilitating monthly convenings and working with participants to develop programmatic activities contributing to CalAIM’s whole system, person-centered approach to care. CPI participants in San Diego County meet regularly to identify Enhanced Care Management (ECM) and Community Supports needs and gaps within the community, identify and resolve implementation issues, and monitor how Providing Access and Transforming Health (PATH) funds can be used to address implementation issues and disseminate best practices. Additionally, Intrepid Ascent hosts monthly office hours and/or CalAIM Academy meetings for continued relationship building and follow-up on key topics.

San Diego Path CPI Collaborative Monthly Meetings (Register Here)

  • Jul 26, 2024 11:30 AM
  • Aug 23, 2024 11:30 AM
  • Sep 27, 2024 - In-Person (Register Here)
  • Oct 25, 2024 11:30 AM
  • Nov 22, 2024 11:30 AM
  • Dec 13, 2024 11:30 AM

Office Hours (Register Here)

  • Jul 11, 2024 11:00 AM
  • Aug 8, 2024 11:00 AM
  • Sep 12, 2024 11:00 AM
  • Oct 10, 2024 11:00 AM
  • Nov 14, 2024 11:00 AM
  • Dec 12, 2024 11:00 AM

If you have any questions or concerns, please contact emily@intrepidascent.com.  

Sign up to receive alerts about future SDAIM events. 

Additional Information and Resources


For more information on CalAIM and associated programs, click below to see additional resources: