Enhanced Care Management (ECM) is a Medi-Cal benefit in California that provides intensive, person-centered care coordination for members with the most complex needs. Unlike traditional case management that happens mostly over the phone or in a clinic, ECM sends a dedicated care manager into the community to meet people wherever they are, whether that’s a shelter, a home, a doctor’s office, or on the street. It launched as part of California’s CalAIM initiative, a broad overhaul of the Medi-Cal system designed to connect healthcare with the social services that shape health outcomes.
How ECM Differs From Standard Care Management
Most health plans offer some form of care management, usually a nurse or coordinator who checks in by phone, helps schedule appointments, and follows up after a hospital stay. ECM sits at the top of that spectrum. It’s the highest care management tier within a Medi-Cal managed care plan’s population health strategy, reserved for people whose needs go well beyond what a phone call can solve.
The key structural difference is location. ECM is built around in-person, community-based engagement. A Lead Care Manager working in this role spends roughly 40% of their time traveling to meet members in the field: at their homes, in hospitals, at parks, or wherever a member is most comfortable. They accompany people to medical appointments, coordinate transportation and interpreter services, and provide health education and coaching face to face. The goal is to break down the traditional walls between healthcare settings and the communities where people actually live.
The other major difference is scope. A standard care manager typically focuses on medical needs. An ECM Lead Care Manager coordinates across medical care, dental care, behavioral health, social work, and community resources. If someone needs help with housing, food access, or substance use treatment, the Lead Care Manager connects those dots rather than telling the member to figure it out on their own.
Who Qualifies for ECM
ECM is not available to every Medi-Cal member. You must be enrolled in a Medi-Cal managed care plan and fall into at least one of the program’s designated Populations of Focus. These are groups identified as having the highest, most complex needs. They generally include people experiencing homelessness, individuals with serious mental illness or substance use disorders, people at risk for institutionalization, children and youth with complex needs, and members with multiple chronic conditions who cycle through emergency rooms and hospitals.
The California Department of Health Care Services (DHCS) established the eligibility criteria statewide, and managed care plans use those criteria to evaluate whether a member qualifies. DHCS has indicated it does not plan to further modify the existing eligibility requirements.
What a Lead Care Manager Actually Does
Each participating member gets assigned a single Lead Care Manager. This person serves as the central point of contact for all of a member’s health and health-related needs. Their responsibilities are broad and practical.
On any given day, a Lead Care Manager might visit a member at home to review their medications, ride with them to a specialist appointment, help them fill out paperwork for housing assistance, or coordinate with a social worker about behavioral health services. They conduct outreach to eligible members through phone calls, mailed information, and field visits. They work from a combination of office settings, homes, hospitals, community centers, and sometimes parks or other public spaces.
The role is fundamentally field-based. Lead Care Managers are expected to deliver services wherever the member lives, seeks care, or finds most accessible. This could mean telehealth for some visits, but in-person engagement is a core requirement, not an afterthought.
How ECM Addresses Non-Medical Needs
One of the defining features of ECM is its explicit focus on factors outside the exam room. Housing instability, food insecurity, lack of transportation, and social isolation all drive poor health outcomes, particularly for the populations ECM targets. The program pairs ECM with a separate but related benefit called Community Supports, which covers specific services like housing navigation, medically tailored meals, and other social interventions.
The Lead Care Manager’s job is to identify these non-medical barriers and connect members with the right resources. Rather than treating a person’s diabetes in isolation while they sleep in a car, ECM tries to address the full picture: the medical condition, the housing situation, the mental health needs, and the gaps in social support that make it nearly impossible to stay healthy.
Early Signs of Impact
ECM is still relatively new, and rigorous long-term outcome data is limited. Early community-level feedback suggests the program has the potential to reduce avoidable emergency room visits and better connect individuals to medical and social services that support recovery and ongoing health. The Institute for Health Policy Leadership at Loma Linda University has noted these emerging positive signals, though large-scale studies measuring hospital readmission rates and cost savings are still catching up to the program’s rollout.
Who Provides ECM Services
ECM providers are typically community-based organizations with deep expertise in serving the specific populations they work with. This is intentional. DHCS requires that ECM providers be able to communicate with members in culturally and linguistically appropriate ways, and to respectfully engage with people who have been historically marginalized or are experiencing health disparities.
Providers must demonstrate the capacity to deliver timely, in-person care management. Some ECM providers are traditional healthcare organizations that enroll through the standard Medi-Cal provider enrollment process. Others, like housing agencies or community organizations, may not have a state-level enrollment pathway. In those cases, the managed care plan is responsible for vetting the provider’s qualifications, including their experience with similar populations, their ability to handle referrals and claims, their business licensing, and their history of any fraud or liability issues.
Managed care plans also require ECM providers to maintain a care management documentation system, ensuring that a member’s care plan, progress, and service coordination are tracked consistently.
How to Get Enrolled
There are several ways to access ECM services. You can ask your primary care provider, doctor, social worker, or another healthcare professional to refer you. You can also contact your managed care plan’s member services department directly to ask whether you qualify. In some cases, an ECM provider may reach out to you proactively if your plan identifies you as eligible.
The specific referral process varies by plan. Some plans use dedicated referral forms submitted by fax or email. Others accept referrals through their websites or over the phone. For example, L.A. Care members can call member services at 1-888-839-9909 to check eligibility, while Santa Clara Family Health Plan members can call 1-800-260-2055. If you’re unsure which managed care plan you’re enrolled in, the DHCS Medi-Cal Managed Care Plan Directory can help you find the right contact information.
Enrollment is voluntary. No one is required to participate, and members can disengage from ECM services at any time. The program is designed to meet people where they are, both physically and in terms of their readiness to engage with care.