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Enhanced Care Management QIP

Enhanced Care Management QIP

Phone number
1-800-541-5555 – Medi‑Cal Member Services / Member Helpline 1-800-407-4627 – Nevada County Medi‑Cal plan (Anthem Blue Cross) contact 1-877-410-8809 – BenefitsCal.com enrollment assistance 1-888-452-8609 – Medi‑Cal Managed Care Ombudsman / appeals line 1-888-809-1340 – Nevada County Health & Human Services 1-800-776-5746 – Disability Rights California (legal help)
Category
Health
Auto tags
Eligibility
people experiencing homelessness or housing instability, frequent ER or hospital users, individuals with serious mental health needs or substance use disorder, those at risk of nursing home placement who wish to stay in the community, individuals leaving jail or prison, children or youth in foster care or the child welfare system, pregnant or postpartum individuals at higher risk for complications
Auto Summary
Enhanced Care Management (ECM) is a free Medi‑Cal benefit that provides eligible individuals with a personal Care Manager offering seven core services, including health assessment, care coordination, education, and connection to social supports. Qualification requires enrollment in a Medi‑Cal managed‑care plan and meeting one of several focus populations such as homelessness, frequent hospital use, serious mental health needs, or being pregnant. Enrollment is coordinated through the member’s managed‑care plan, which can be contacted via the numbers on the Medi‑Cal card or listed helplines, and referrals can also come from providers or family. The program does not require direct application, and common pitfalls include needing a managed‑care plan and distinguishing ECM from standard case management.
Value
No content
Espanol
Gestión Mejorada de la Atención QIP
URL
https://www.dhcs.ca.gov/CalAIM/ECM/Pages/Home.aspx
Last verified 2026-05-17
Enhanced Care Management (ECM) is a free Medi-Cal benefit. If you qualify, you get a personal Care Manager who helps you with doctor visits, medicine, housing, food, transportation, mental health, and any other support you need. They come to you — at home, at a shelter, on the phone, or wherever works. You do not pay anything extra.

Who qualifies

You must be enrolled in a Medi-Cal managed care plan AND fit at least one of these "Populations of Focus":
  • You are experiencing homelessness or housing instability
  • You go to the ER or hospital often (multiple visits in the last 6–12 months)
  • You have serious mental health needs or substance use disorder
  • You are at risk of needing a nursing home but want to stay in the community
  • You are leaving jail or prison and returning to the community
  • You are a child or youth in foster care, the child welfare system, or California Children's Services (CCS)
  • You are pregnant or postpartum and at higher risk for complications
[Source: dhcs.ca.gov/CalAIM/ECM/Documents/CalAIM-ECM-Policy-Guide.pdf (accessed 2026-05-17)]

What you get

A Care Manager who works for you and gives you seven core services:
  1. Outreach and engagement (they find you, meet you where you are)
  1. A full health assessment and a written care plan
  1. Coordination across your doctors, specialists, pharmacy, and county services
  1. Health education and coaching
  1. Help moving between hospital, home, or other settings safely
  1. Support for your family or chosen caregivers
  1. Connection to housing, food, legal aid, and other social services
[Source: mss.anthem.com/california-medicaid/benefits/medi-cal-plan-benefits/care-management.html (accessed 2026-05-17)]

How to apply

You do not apply directly. Your Medi-Cal managed care plan finds you — OR you can ask them to refer you.
  1. Find your plan: look at the back of your Medi-Cal card, or call Medi-Cal Member Services at 1-800-541-5555.
  1. Call your plan's Member Services line and ask: "Am I eligible for Enhanced Care Management? I want a referral."
  1. If you are in Nevada County, your Medi-Cal plan is Anthem Blue Cross Partnership Plan — call 1-800-407-4627 (TTY 711).
  1. A doctor, social worker, county worker, shelter staffer, or family member can also refer you. So can you, for yourself.
Your plan must respond and tell you if you qualify. If you qualify, they will assign you to an ECM provider in your area.

Common pitfalls

  • You must already have Medi-Cal. If you do not, apply first at BenefitsCal.com or call 1-877-410-8809 (Nevada County Health & Human Services).
  • Fee-for-service Medi-Cal does NOT get ECM — you need to be in a managed care plan. Most Medi-Cal members are.
  • ECM is not the same as a regular case manager. It is more intensive and meets you in person.
  • You can have ECM and Community Supports at the same time (housing help, medically tailored meals, sobering centers — different benefit, same CalAIM program).
  • If your plan says no, you can appeal. Ask for the denial in writing and call the Medi-Cal Ombudsman at 1-888-452-8609.

Where to get help

  • Your Medi-Cal plan's Member Services — number on your card
  • Medi-Cal Member Helpline: 1-800-541-5555
  • Medi-Cal Managed Care Ombudsman: 1-888-452-8609
  • Nevada County Health & Human Services: 1-888-809-1340
  • Disability Rights California (free legal help with denials): 1-800-776-5746

Sources