Enhanced Care Management will address clinical and non-clinical needs of the highest-need enrollees through intensive coordination of health and health-related services. It will meet enrollees wherever they are – on the street, in a shelter, in their doctor’s office, or at home.
Additionally, enrollees will have connections to Community Supports to meet their social needs, including medically supportive foods or housing supports. Enrollees will have a single Enhanced Care Manager who will coordinate care and services among the physical, behavioral, dental, developmental, and social services delivery systems, making it easier for them to get the right care at the right time.
What is Enhanced Care Management?
Enhanced Care Management will be a whole-person, interdisciplinary approach to comprehensive care management that addresses the clinical and non-clinical needs of high-cost, high-need managed care members through systematic coordination of services that is community-based, interdisciplinary, high-touch, and person- and person-centered.
Enhanced Care Management is the key part of CalAIM. It’s a new statewide Medi-cal benefit available to “populations of focus”, including:
- Individuals and families experiencing homelessness.
- Adults, youth, and children who are high utilizers of avoidable emergency department, hospital, or short-term skilled nursing facility services.
- Adults with serious mental illness or substance use disorder.
- Children and youth with serious emotional disturbance, identified to be at clinical high risk for psychosis or experiencing a first episode of psychosis.
- Adults and youth who are incarcerated and transitioning to the community.
- Adults at risk of institutionalization and eligible for long-term care.
- Adult nursing facility residents transitioning to the community.
- Children and youth enrolled in California Children’s Services (CCS) with additional needs beyond CCS.
- Children and youth involved in child welfare (including those with a history of involvement in welfare, and foster care up to age 26)
Enhanced Care Management will coordinate care and services among the physical, behavioral, dental, developmental, and social services delivery systems, making it easier for them to get the right care at the right time.
