FAQs and Resources

ECM is a state-wide CalAIM benefit that replaces the now-ended Health Homes Program (HHP) and Whole Person Care (WPC) pilots as of January 1, 2022. 

This new five-year benefit provides comprehensive care management services to members with highly complex needs. ECM addresses both the clinical and social determinants of health needs of high-cost and high-need members. 

ECM services are interdisciplinary, team-based, high-touch and person-centered.

Dual eligible members may be eligible for ECM through their Medi-Cal Managed Care Plan if they meet the applicable Populations of Focus criteria and if they are not enrolled in any of the exclusionary programs that are duplicative of ECM. 

D-SNP Members are not eligible for ECM services because they already receive care management services provided by the health plan as part of the member’s D-SNP benefits. Beginning on 1/1/2024, Dual Special Needs Plan (D-SNP) members enrolled in a Medi-Cal MCP who have an active authorization to receive Medi-Cal ECM at the end of 2023 will continue to receive ECM through their Medi-Cal MCP for a period of up to 12 months, or until the Member meets any of the circumstances for discontinuing ECM, as outlined in Section VIII of the ECM Policy Guide. 

Please see L.A. Care’s Enhanced Care Management Dual Members Guide in the “additional resources” section below.

Yes. MCP Members can be enrolled in both SMHS Targeted Case Management and ECM. ECM can enhance case management services and/or help coordinate across the whole person, including physical health needs. The MCP must ensure nonduplication of services for Members enrolled in both programs.

With regards to the Populations of Focus checklist, specifically Adults with Serious Mental Illness or Substance Use Disorder, you can determine if an individual is eligible for obtaining services through the County Specialty Mental Health (SMH) system or the Drug Medi-Cal Organized Delivery System (ODS) by checking Appendix B: Access Criteria for SMHS, DMC-ODS, and DMC in the Department of Health Care Services Enhanced Care Management (ECM) Policy Guide, for eligibility requirements.

There are portals in place to receive this information regarding existing patients, including ADT (admission, discharge, transfer) data for existing clinic patients. You can also receive this information from the member's Health Plan. 

If unable to verify when referring the member, note on the form how you received the information (e.g. patient self-report, hospital referral). 

NOTE: For this population of focus, MCPs may choose to authorize ECM for individuals who are at risk for avoidable hospital or ED utilization and who would benefit from ECM but who may not meet the numerical thresholds specified above. This flexibility is in addition to and does not displace the numerical thresholds provided in the eligibility criteria.

If you suspect that an individual may be in a program that may be exclusionary or duplicative, but are unable to verify, it is encouraged that you still submit the referral form. Please ensure to note this on the Referral form when submitting to the Health Plan. 

Once the referral form is received by the Health Plan, the referral will be reviewed to confirm member eligibility. 

As providers continue to work with members, it may be discovered that a member is in a program that is considered duplicative or exclusionary of ECM. If the program is duplicative, the member must make a choice of either the ECM benefit or the other program. If the program is exclusionary, the member must be disenrolled from the ECM benefit.