ENHANCED CARE MANAGEMENT AND COMMUNITY SUPPORTS
Enhanced Care Management (ECM)
Enhanced Care Management (ECM) is a Medi-Cal care management benefit. Enhanced Care Management offers extra services at no cost to Medi-Cal 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 and can connect the member with core community and social services.
How to request Enhanced Care Management
Talk to your doctor or call Blue Shield Promise Customer Care to see if you are eligible for ECM services.
Who can get Enhanced Care Management (ECM)
Members enrolled in a Medi-Cal managed care health plan who meet eligibility requirements can get ECM services. If you qualify, using ECM services is your choice.
People who qualify
ECM is for Medi-Cal members with the most complex medical and social needs.
Individuals who qualify:
- May have a medical condition that requires frequent use of the health system or serious mental health needs
- Are currently experiencing homelessness or have in the past
- Are transitioning from incarceration or juvenile detention
New eligibility factors will be added over the next year. Call Blue Shield Promise at the numbers listed near the bottom of this page to learn more.
What are Community Supports?
Community Supports are services covered by Medi-Cal, but not delivered by the State. Medi-Cal members may be eligible for and use of medically appropriate Community Supports offered by Blue Shield Promise. Prior service authorization is required.
| Community Supports offered by Blue Shield Promise | |
|---|---|
| Housing Transition Navigation Services | help obtaining housing |
| Housing Deposits | help finding, coordinating, securing, or funding one-time services needed to set up a basic household |
| Housing Tenancy and Sustaining Services | help maintaining safe and stable tenancy after finding housing |
| Short-Term Post-Hospitalization Housing | a place for members with high medical or behavioral needs who do not have a residence to continue recovering immediately after exiting an inpatient hospital or residential facility |
| Recuperative Care (Medical Respite) | short-term residential care for those who no longer require hospitalization, but still need to heal from an injury or illness, including a mental health condition that might worsen in an unstable living environment |
| Respite Services for caregivers of Medi-Cal members | short-term, non-medical relief from caregiving duties for those who take care of Medi-Cal members who require intermittent temporary supervision |
| Day Habilitation Programs | help for Medi-Cal members in a non-facility setting to develop self-help, socialization, and adaptive skills necessary to succeed in their home environments |
| Personal Care and Homemaker Services | help with Activities of Daily Living (ADLs) such as bathing, dressing, toileting, ambulation, or feeding, and Personal Care Services like meal preparation, grocery shopping, and money management for members who could not otherwise remain in their homes without these supports |
| Environmental Accessibility Adaptations (Home Modifications) | physical adaptations to a home to ensure the health, welfare, and safety of the individual and allow members who would otherwise require institutionalization to stay in their homes |
| Medically Tailored Meals/Medically-Supportive Food | nutritional support for members, especially those with chronic conditions, when meeting nutritional goals is critical to getting healthy and staying healthy |
| Sobering Centers | safe, supportive places for individuals to become sober after being found publicly intoxicated due to alcohol or drugs and help for individuals experiencing homelessness or unstable living situations who would otherwise be sent to the emergency department or jail |
| Asthma Remediation | physical changes to an individual’s home environment that ensure health, welfare, and safety, or enable functioning at home if acute asthma episodes may result in hospitalization or seeking emergency services |
More information
You can learn more about Enhanced Care Management (ECM) and Community Supports (CS) from the resources listed below.
Information for members
- Call the Blue Shield Promise Customer Care number for your region on weekdays between 8 a.m. and 6 p.m.
Los Angeles: (800) 605-2556
San Diego: (855) 699-5557 - Call Health Care Options (HCO) at (800) 430-4263 (TTY 800-430-7077)
- Enhanced Care Management (ECM) Member Toolkit
Information for providers
- Email Blue Shield Promise in your region:
Los Angeles providers: LACommunitySupports@blueshieldca.com
San Diego providers: SDCommunitySupports@blueshieldca.com - Blue Shield Promise Provider Connection: Community Supports
- Enhanced Care Management (ECM) Provider Toolkit