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.

Contracted provider log-in

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:

  • Homeless families or unaccompanied children/youth experiencing homelessness
  • Children and youth at risk for avoidable hospital or ED utilization
  • Children and youth with serious mental health and/or SUD needs
  • Children and youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with additional needs beyond the CCS condition
  • Children and youth involved in child welfare
  • Children and youth with intellectual or developmental disabilities (I/DD)
  • Pregnant or postpartum 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

Online ECM referral form

 

Download PDF form

  Referral Form (PDF, 273 KB)

Extra Medi-Cal services for provider referrals

Community Supports are extra services that are offered to eligible Medi-Cal members. Find out how to refer eligible members.

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