Enhanced Care Management is a benefit for Medi-Cal members. It comes from a new Medi-Cal program
called California Advancing and Innovating Medi-Cal, also called CalAIM. This benefit helps members
with complex needs coordinate their health care.
Since you qualify for ECM, we will be working to connect you with an ECM team from one of our qualified
contracted providers. This team includes a lead case manager. Your lead case manager will talk with
doctors, mental health providers, specialists, pharmacists, case managers, social services providers and
others. They will make sure everyone works together to get you the care you need. A lead care manager
can also help you find and apply for other services in the community.
An ECM lead care manager can help you:
• Find doctors.
• Schedule appointments for health-related services.
• Manage medications.
• Set up a ride to go to the doctor or pharmacy.
• Find and apply for community-based services that you need. These services include support with
housing or medically nutritious food.
• Set up follow-up care after the hospital.
Suggested Provider Script:
The Alliance (your managed care plan, Medi-cal provider) has determined you are eligible to receive
ECM services based on information they have on file from their internal database or information that
was shared with them regarding your current situation. In order for us to begin supporting you, we want
to take some time to review what the program is and what we can do to support in meeting your needs.
As the Alliance may have already mentioned to you, or if they have not, as an ECM provider we have a
team of people that will be working together to make sure you get the care you need. This is a process
that is approved for 6 months at a time. As an ECM provider our goal is to talk to your primary care
doctor, mental health providers, specialty doctors, pharmacists, case managers, social services providers
and others to coordinate care and work on helping you improve your overall health. We can also help
you find and apply for other services in the community if these are impacting your health and ability to
live safely. This is different from other case management services because we would be meeting with
you frequently and in-person. We will ask to meet with you in-person to provide you with the best
possible support and work on a meeting schedule that best fits your needs. As an ECM provider some of
the things we do will include:
• Finding doctor, if needed
• Scheduling appointments for health-related services.
• Managing medications- helping to make sure you have the medications you need
• Setting up a ride to go to the doctor or pharmacy.
• Finding and applying for community-based services that you need. These services can
include support with housing or medically nutritious food.
• Setting up follow-up care if you are admitted or go to the hospital
If you agree to receive these services we will assign you a lead case manager who will begin working
with you to develop a care plan. We will need to ask questions about your health history, social
situation, and ask you about goals and other services you need to be healthy. This will help us be in the
best position to support you and your needs. If you chose not to participate at this time, you can chose
to participate at any point and time again if you wish. You will just need to contact the Alliance or us so
we can process a new request.
If you have any questions about the process, including how you were approved, or during the process
you can call the Alliance anytime at 800-700-3874 or (provider info).