Enhanced Care Management and Community Supports
Starting in 2022, San Ysidro Health will offer services to eligible members through Enhanced Care Management. This program will help people with complex health issues and people who need help setting up their medical care. They can help you get healthy and stay as healthy as possible.
Enhanced Care Management (ECM) can help you set up essential medical care and get other community services or resources. ECM services starts January 1, 2022 in San Diego County.
Community Supports can help you with housing, food, substance use disorders and more in direct coordination with your health plan.
Enhanced Care Management FAQs
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 your with 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 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. These services include 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:
- Enrolled in a Medi-Cal managed care health plan
- Meet certain eligibility requirements.
These 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 other services for Medi-Cal members that may not include direct medical care. Community Supports are provided by your health plan when referred by SYHealth as part of ECM to help members with complex health issues. These health issues are often caused or made worse by lack of food, housing or transportation.
Community Supports include:
- Medically Tailored Meals
- Housing Transition Navigation Services
- Housing Deposits
- Housing Tenancy and Sustaining Services
- Recuperative Care
- Short-Term Post Hospitalization Housing
- Sobering Centers (when available)
The Medically Tailored Meals program provides meals to members after they leave the hospital or a skilled nursing facility. Meals are tailored to each member’s needs based on their medical conditions. You may also get help with case management and nutrition support to help you stay healthy.
Housing Transition Navigation Services can help you find and apply for housing. You can also get help with setting up your rental process.
Housing Deposits can help you get one-time funding for housing and establish a basic household. Housing deposit services are not the same as room and board.
Housing Tenancy and Sustaining Services can help you maintain safe and stable tenancy once you get housing. You can also get training in:
- Independent living.
- Life skills like budgeting and financial literacy.
- Connecting to community resources.
Recuperative Care provides temporary housing, medical care and other services. The program is for members who are homeless and recovering from an acute illness or injury. These services include case management, self-management support and help with housing.
Short-Term Post Hospitalization Housing provides residential and supportive services. This is for members who have high medical or behavioral health needs. Through this housing service, members can continue their recovery right after leaving any of the following:
- Inpatient hospital
- Residential substance use disorder treatment or recovery facility
- Residential mental health treatment facility
- Correctional facility
- Nursing facility
- Recuperative care
Sobering Centers are places for people who are found to be publicly intoxicated (due to alcohol and/or other drugs). They provide a space for people who would otherwise have to go to the emergency department or jail. Sobering centers provide a safe, supportive environment to become sober and receive referrals for services. This service is mainly for people who are homeless or living in unstable situations.
Who Can Receive Community Supports?
Your ECM Case Manager can refer you to Community Supports. You or your family may also ask to get Community Supports.
Members who are currently in the following programs will continue to get services through Community Supports:
- Post-Discharge Meal Delivery Program – This program provides meals to members after they leave the hospital or skilled nursing facility. The meals are tailored for the member’s medical needs. Members can also get help with case management and nutrition support to help them stay healthy.
- Recuperative Care Pilot – This program offers temporary housing solutions, medical care and other supports. This program is for members who are experiencing homeless and recovering from an acute illness or injury. Services include case management, self-management support and help with housing. If you are getting Recuperative Care Pilot services, you will continue to get these services through Community Supports beginning July 1, 2022.
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!
Please call us at 1- 833-503-5910 Option #2, Email: ECM@syhealth.org or call your Medi-Cal health plan if you are interested in learning more.