Enhanced Care Management and Community Supports

San Ysidro Health offers services to eligible members through Enhanced Care Management (ECM). This program helps people with complex health issues and people who need help setting up their medical care. Our goal is to help you get healthy and stay healthy.

Through ECM, individuals may qualify for additional Community Supports which can help with resources such as housing and food, as well as support for those who have experienced or are experiencing homelessness.

‍What are Enhanced Care Management (ECM) Services? 

Enhanced Care Management (ECM) is a new 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 care.

If you qualify for ECM, you will be assigned 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 case manager can also help you find and apply for other services in the community.

An ECM lead case 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
• Get support with housing or medically nutritious food
• Set up follow-up care after the hospital

Who can get ECM Services? 

To get ECM services, you must be: 

1. Enrolled in a Medi-Cal managed care health plan

2. Meet certain eligibility requirements

The following members can get ECM services starting January 1, 2022:

• Adults and families who do not have stable housing
• Adults who were or are getting Whole Person Care services through San Diego County
• Adults who have complex health issues and needed to go to the hospital or emergency department many times over the last six months
• Adults who have a serious mental health condition or have a hard time with drug or alcohol use

What are Community Supports?

Community Supports are support services tht help address health issues often caused or made worse by lack of food, housing, or transportation. Community Supports are available to Medi-Cal members through a referral, as part of the Enhanced Care Management program.

Community Supports include:

• Housing Transition Navigation Services 
• Housing Deposits 
• Housing Tenancy and Sustaining Services 
• Short-Term Post-Hospitalization Housing 
• Recuperative Care (Medical Respite) 
• Respite Services
• Day Habilitation Programs 
• Nursing Facility Transition/Diversion to Assisted Living Facilities, such as 
• Residential Care Facilities for Elderly (RCFE) and Adult Residential Facilities (ARF)
• Community Transition Services/Nursing Facility Transition to a Home 
• Personal Care and Homemaker Services 
• Environmental Accessibility Adaptations (Home Modifications) 
• Medically Supportive Food/Meals/Medically Tailored Meals 
• Sobering Centers 
• Asthma Remediation 

‍Who can receive Community Supports?

Your Enhanced Care Management (ECM) Case Manager can refer you to Community Supports. You or your family may also ask to get Community Supports.

‍When can I get Community Supports? 

If you are already enrolled in Enhanced Care Management (ECM), you will be assigned with a case manager who will assist and provide you with all the information including what will be required to receive Community Supports directly from your health plan. 

‍Contact Us:

To learn more, call us at (833) 503-5910, option #2 or email us at ECM@syhealth.org. You can also call your Medi-Cal health plan for additional information. 

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