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 ECM?
You can talk to your doctor or call Blue Shield Promise Customer Care. They can help check if you qualify for ECM services.
Blue Shield Promise offers the following ECM 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 substance use 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 | |
Visit the Department of Health Care Services for more information.
For healthcare providers, visit the Provider Connection Portal.
Extra services Blue Shield Promise offers
Community Supports are extra services that are offered to eligible members. Visit the Community Supports page to find out if you’re eligible.
Last updated: 07/07/2023
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