CalAIM

Benefit Changes under Medi-Cal:

Enhanced Care Management & Community Supports

We would like to tell you about some new services available through your CenCal Health insurance starting on July 1, 2022.

California seeks to improve the Medi-Cal program for people with complex needs and who are facing difficult life and health circumstances. These new services are focused on providing assistance beyond traditional medical services. They are designed to address social drivers of health (factors in people’s lives that influence their health). Enhanced Care Management and Community Supports are the names of two new, statewide Medi-Cal services.

The section below is what will be changed in the Member Handbook/ Evidence of Coverage (EOC) soon. Please keep this page for your records until the Member Handbook (EOC) is updated and shared with you.

Enhanced Care Management

Enhanced Care Management (ECM) is a new benefit for CenCal Health Members with complex needs.

ECM provides extra services to help you get the care you need to stay healthy and at no cost to you. It coordinates the care you get from different doctors.

ECM helps coordinate:

  • Primary care
  • Acute care
  • Behavioral health
  • Developmental Health
  • Oral health
  • Community-based long-term services and supports (LTSS)
  • Referrals to available community resources

ECM Lead Care Manager

If you qualify for ECM, you will be contacted by an ECM provider.

This provider may be your PCP office or a government or community agency. The ECM provider will help you enroll in the ECM program and assign you a lead care manager.

This person will coordinate care between:

  • You
  • our doctors
  • Specialists
  • Pharmacists
  • Case managers
  • Social services providers
  • Others

They will make sure everyone works together to get you the care you need. The lead care manager can also help you find and apply for other services in your community.

You can also call CenCal Health Member Services at 1-877-814-1861 (TTY/TDD 1-833- 556-2560 or 711) to find out if and when you can receive ECM. Or you can talk to your health care provider.

ECM services include:

  • Outreach and engagement
  • Comprehensive assessment and care management
  • Enhanced coordination of care
  • Health promotion
  • Comprehensive transitional care
  • Member and family support services
  • Coordination and referral to community and social supports (link to ECM Referral Form- in production)
  • DHCS information
  • ECM Member Toolkit (hosted by Aurrera)

Community Supports

What are Community Supports?

Community Supports are optional services for Medi-Cal members that may not include direct medical care. CenCal Health offers Community Supports free of charge, 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
  • Recuperative Care

The Medically Tailored Meals program provides meals to members with:

  • Diabetes
  • Congestive heart failure
  • Chronic kidney disease &
  • Who have had a skilled nursing facility stay, inpatient hospital visit or two emergency room (ED) visits within 12 months

Meals are made for each member’s needs based on their medical conditions. Nutrition support is available to help you stay healthy.

Recuperative Care services are for members who are:

  • Homeless
  • Recovering from an acute illness or injury
  • Being discharged from the hospital

Recuperative Care provides:

  • Temporary housing
  • Medical care
  • Case management
  • Self-management support
  • Help with housing

How do I get Community Supports?

You can be referred to Community Supports by:

  • Your ECM provider
  • Primary doctor
  • Social services providers
  • Other providers
  • Yourself or your family

When can I get Community Supports?

Community Supports will be available to eligible members starting July 1, 2022.

Who do I call if I have questions about Community Supports?

You can call CenCal Health Member Services at 1-877-814-1861 Monday to Friday, 8a.m. to 5p.m. (TTY/TDD 1-833- 556-2560 or 711).

To learn more, click here: Errata