Enhanced Care Management FAQs and Webinar 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. 

The ECM model of care provides the highest level of care management to the clinically and socially complex member.

It is very similar to HHP, with a majority of HHP Care Teams transitioning over as ECM providers.

The Core Services provided in ECM and HHP are essentially the same, with the exception of Outreach and Engagement added as a Core Service to ECM (which HHP prioritized in practice).

Other differences between the services include the removal of Housing Transition/ Tenancy Sustaining Services in ECM; these services are transferring to the Community Supports (CS) Program. Members receiving these services in HHP will receive them through CS.

ECM also expands eligibility to additional populations with criteria attached to each.

As ECM is a benefit for MediCal members enrolled in a Health Plan, non-Medi-Cal members are not be eligible.  The recommendation to the ECM provider is to support the HHP member in re-accessing Medi-Cal benefit in order to be eligible for ECM.   

Individuals receiving both Medi-Cal and Medicare coverage can receive ECM if they meet Population of Focus criteria.  The Exclusionary Checklist tool lists the specific plans that dually eligible individuals can be enrolled in while also participating in ECM:

• Dual Eligible Special Needs Plans (D-SNPs) 
• D-SNP Look-alike Plans
• Other Medicare Advantage Plans
• Medicare FFS

Duals with managed care Medi-Cal and Medicare FFS are ECM eligible, but Cal MediConnect duals (or duals enrolled in other Medicare Advantage plans) are not.

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).