Enhanced Care Management
Enhanced Care Management
Enhanced Care Management (ECM) is a Medi-Cal care management benefit. ECM offers extra services to members with complex needs that make it difficult to improve their health. This could include health conditions or challenges such as not having a place to live.
Working with an ECM care team
Qualified members who enroll in ECM are paired with a care team. The care team works with the member to make a care plan. This can include connecting members with core community and social services.
Who can get ECM?
Members must be enrolled in a Medi-Cal managed care health plan. They must meet eligibility requirements to receive ECM services. If they qualify, using ECM services is their choice.
People who qualify
ECM is for Medi-Cal members with the most complex medical and social needs. It is available to select “Populations of Focus”. It will address the clinical and non-clinical needs of the highest-need members. Members will be picked with the help of health and health-related services.
How to request Enhanced Care Management
Members can talk to their doctor or call Blue Shield Promise Customer Care.
To check if a member qualifies for ECM services, email Blue Shield Promise Enhanced Care Management: ECM@blueshieldca.com
To contact the Justice Involved Managed Care Plan Liaison:
Phone: (800) 393-1542
Email: ECM@blueshieldca.com
Blue Shield of California Promise Health Plan offers the following ECM services to eligible Medi-Cal members in Los Angeles and San Diego Counties:
Enhanced Care Management populations of focus |
|
| Adults and their families experiencing homelessness | Adults at risk for avoidable hospital or emergency department (ED) utilization (formerly “High Utilizers”) |
| Adults with serious mental health or substanceuse disorder (SUD) needs | Individuals transitioning from incarceration |
| Adults with intellectual or developmental disabilities (I/DD) | Pregnant or postpartum adults |
| Adults living in the community and at risk for Long Term Care (LTC) Institutionalization | Adult nursing facility residents transitioning to the community |
| Effective July 1, 2023 | |
| Adults without dependent children/youth living with them experiencing homelessness | Children and youth:
|
| Effective January 1, 2024 | |
| Pregnant or postpartum youth and adults in racial and ethnic groups experiencing disparities in care for maternal morbidity and mortality | |
For additional information or to refer members to Enhanced Care Management, email ECM@blueshieldca.com.
Instructions for using new features on the Enhanced Care Management and Community Supports provider portal
Instructions for using the correspondence tab (PDF, 47 KB)
Instructions for using the Admission, Discharge, Transfer (ADT) feature (PDF, 61 KB)
Important documents
Health Risk Assessment (HRA) Form (PDF, 273 KB)
Referral forms
Online form
Download PDF form
Referral Form (PDF, 273 KB)