{"id":6305,"date":"2026-06-04T00:08:47","date_gmt":"2026-06-04T00:08:47","guid":{"rendered":"https:\/\/24hourcares.mgldevs.com\/resource\/\/"},"modified":"2026-06-04T00:08:48","modified_gmt":"2026-06-04T00:08:48","slug":"calaim-enhanced-care-management","status":"publish","type":"resource","link":"https:\/\/24hourcares.mgldevs.com\/es\/resource\/calaim-enhanced-care-management\/","title":{"rendered":"CalAIM Enhanced Care Management"},"content":{"rendered":"<p class=\"wp-block-paragraph\"><em>Enhanced Care Management serves Californians who need the most help in coordinating care, taking a holistic approach to improving health outcomes.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Enhanced Care Management (ECM) is a California statewide Medi-Cal benefit designed for members with the most complex medical and social needs. It\u2019s a response to a medical crisis that had been growing for decades.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">People experiencing homelessness, serious mental illness, or complex medical conditions landed in emergency rooms\u2014not because the ER was the right place for them, but because there was nowhere else to turn. Once discharged, they returned to the same circumstances that brought them in. No one coordinated their care. No one addressed the housing instability, food insecurity, or lack of support that drove their health outcomes in the first place.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In this blog, we\u2019ll look at how <strong>CalAIM Enhanced Care Management <\/strong>changed that, examining:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>What is CalAIM<\/li>\n\n\n\n<li>What is Enhanced Care Management (ECM)<\/li>\n\n\n\n<li>ECM core services<\/li>\n\n\n\n<li>How ECM and Community Supports work together<\/li>\n\n\n\n<li>Who is eligible for ECM<\/li>\n\n\n\n<li>How to refer to CalAIM ECM<\/li>\n\n\n\n<li>How 24 Hour can help<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">What is CalAIM?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">California Advancing and Innovating Medi-Cal <a href=\"https:\/\/24hourcares.mgldevs.com\/es\/resource\/what-is-calaim\/\" data-type=\"resource\" data-id=\"6075\">(CalAIM)<\/a> is a multi-year initiative to transform California\u2019s Medicaid program, shifting from a traditional medical model to <strong>\u201cwhole-person care.\u201d<\/strong> It goes beyond the walls of hospitals where Medi-Cal members seek treatment and reaches into their community to tackle the drivers of health issues.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One of CalAIM\u2019s core goals is to address the \u201csocial determinants of health,\u201d managing member risk by focusing on non-medical factors like <strong>housing, food insecurity, and transportation.<\/strong> It also seeks to create a more coordinated, consistent statewide Medi-Cal program, and improve the equity and quality of health care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Run by the Department of Health Care Services (DHCS), <a href=\"https:\/\/calaim.dhcs.ca.gov\/\" target=\"_blank\" rel=\"noopener\">CalAIM<\/a> has many sub-initiatives to achieve its goals, but two in particular are frontline tools in its whole-person care model: Enhanced Care Management (ECM) and Community Supports. ECM targets individuals who require the highest tier of care management. Community Supports serves a broader population, but, like ECM, also addresses non-medical health drivers, such as housing assistance and medically tailored meals.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What is Enhanced Care Management?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Enhanced Care Management <\/strong>serves Medi-Cal populations of all ages with the most complex medical and social needs. It\u2019s a statewide managed care plan benefit, providing high-need members with in-person care management wherever they are\u2014at home, at their doctor\u2019s office, in a shelter, or on the street.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/calaim.dhcs.ca.gov\/pages\/enhanced-care-management\" target=\"_blank\" rel=\"noopener\">ECM<\/a> is delivered through contracted community-based organizations, not the health plan directly. The health plan provides the funding, and the community-based organization provides the local knowledge and \u201cboots on the ground\u201d to meet face-to-face with members and provide whole person care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The main hallmark of ECM is the <strong>Lead Care Manager<\/strong> who serves as the single point of contact for the member and coordinates all aspects of their care. The Lead Care Manager role dramatically improves the coordination of care for individuals with the most complex needs and who often struggle to navigate the services available to them.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Let\u2019s look at an example at how the Lead Care Manager drives the whole-person care model. Jamie is homeless and has diabetes. Her Lead Care Manager, Sam, meets her in her encampment to start the ECM processes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Whole-Person Assessment: <\/strong>Sam asks Jamie about her physical health as well as housing history, food access, and legal barriers that could prevent her from obtaining housing, employment, or services.\u00a0<\/li>\n\n\n\n<li><strong>Foundational Paperwork: <\/strong>Lack of documentation and navigating forms can be a major barrier for homeless people to receive care and services. Sam helps Jamie request a replacement Social Security card and birth certificate; apply for Medi-Cal renewals so coverage doesn\u2019t lapse and Disability (SSI) to secure long-term income.<\/li>\n\n\n\n<li><strong>Medical and Behavioral Care:<\/strong> Sam schedules a doctor\u2019s appointment for Jamie and arranges the transportation to get her there. He ensures her prescriptions are filled and delivered to a location Jamie can reach.\u00a0<\/li>\n\n\n\n<li><strong>Housing:<\/strong> Sam finds an available apartment that works for Jamie, helps her complete the background check, and requests funding via Jamie\u2019s Medi-Cal plan to pay the security deposit and first month\u2019s rent. Once Jamie moves in, Sam visits regularly to ensure Jamie understands her lease and doesn\u2019t get evicted.<\/li>\n\n\n\n<li><strong>Hospitalization:<\/strong> When Jamie is unexpectedly hospitalized, Sam is notified through CalAIM\u2019s Data Exchange Framework. Sam visits Jamie in the hospital and ensures the discharge plan includes the medical and non-medical support she needs.<\/li>\n\n\n\n<li><strong>In-home care: <\/strong>In recovery, Sam coordinates with a care provider to get Jamie medically tailored meals through the Community Supports program.\u00a0<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">ECM Core Services<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">ECM provides seven core services to help manage and coordinate care, and to connect with community and social services.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Outreach and Engagement: <\/strong>Active, &#8220;high-touch&#8221; efforts to find and build trust with eligible members, often meeting them in person where they live or seek care.\u00a0<\/li>\n\n\n\n<li><strong>Comprehensive Assessment and Care Management Planning: <\/strong>Conducted by a Lead Care Manager, this involves a deep dive into a member&#8217;s physical, mental, and social needs to create a personalized roadmap for their health.<\/li>\n\n\n\n<li><strong>Enhanced Coordination of Care: <\/strong>The core organizing work, such as scheduling doctor appointments, coordinating transportation, managing medication reconciliations, and ensuring the entire care team is aware of the member\u2019s health status and treatments.<\/li>\n\n\n\n<li><strong>Health Promotion: <\/strong>Educating and coaching members to be able to manage their own health, including linking members to resources for smoking cessation, chronic condition management, and self-help recovery resources.<\/li>\n\n\n\n<li><strong>Comprehensive Transitional Care: <\/strong>Focused support during major moves (e.g., leaving a hospital, nursing facility, or correctional facility) to ensure the member has immediate access to the resources they need.<\/li>\n\n\n\n<li><strong>Member and Family Supports: <\/strong>Ensuring the member\u2019s caregivers or family members understand their condition and care plan so they can provide effective support at home.<\/li>\n\n\n\n<li><strong>Coordination of and Referral to Community and Social Support Services: <\/strong>Directly linking members to Community Supports services (e.g., housing deposits or meals) and other non-medical resources (e.g., food banks or legal aid).<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Who is Eligible for ECM?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">ECM is designed to provide services to Californians with the most complex needs, regardless of age. As a CalAIM program, eligibility is based on Medi-Cal Populations of Focus, identifying specific groups who often have serious health issues as a result of related social factors. Adult Populations of Focus include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Individuals who are <strong>experiencing homelessness <\/strong>and have at least one complex physical, behavioral, or developmental health need<\/li>\n\n\n\n<li>Individuals who are considered <strong>high utilizers of care<\/strong> and those who have been identified by their health plan as having a pattern of high utilization that could have been avoided<\/li>\n\n\n\n<li>Adults with<strong> serious mental illness or substance use disorder (SUD)<\/strong> who are experiencing at least one complex social factor and meet additional criteria<\/li>\n\n\n\n<li>Individuals <strong>transitioning from incarceration<\/strong>, or who have transitioned from incarceration within the past 12 months, who also have certain medical conditions<\/li>\n\n\n\n<li><strong>Nursing facility residents <\/strong>who want to transition to the community and are strong candidates for a successful transition<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Children\/Youth Populations of Focus include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Children (up to age 21) <strong>experiencing homelessness<\/strong><\/li>\n\n\n\n<li>Children who are considered<strong> high utilizers of care<\/strong>, including children or youth who are frequently hospitalized and those who regularly use emergency rooms as a source of care.<\/li>\n\n\n\n<li>Children with <strong>significant behavioral health needs<\/strong><\/li>\n\n\n\n<li>Children enrolled in California Children\u2019s Services (CCS) or the CCS Whole Child Model who have additional <strong>needs beyond the CCS qualifying condition<\/strong><\/li>\n\n\n\n<li>Children involved in (or with a history of involvement in) <strong>child welfare<\/strong>, including foster care up to age 26<\/li>\n\n\n\n<li>Children <strong>transitioning from incarceration<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">How ECM and Community Supports Work Together<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CalAIM\u2019s Community Supports program provides services to help members live healthier, and to avoid higher, costlier levels of care. Formerly known as In-Lieu of Services (ILOS), these Community Supports are cost-effective, medically appropriate alternatives to traditional Medi-Cal services, such as nursing facility stays or hospitalizations.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are 14 defined Community Supports under the categories of:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Housing Stability Supports<\/li>\n\n\n\n<li>Transition Supports<\/li>\n\n\n\n<li>Long-Term Care Supports<\/li>\n\n\n\n<li>Auxiliary Supports<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/24hourcares.mgldevs.com\/wp-content\/uploads\/2026\/06\/image-1024x683.png\" alt=\"\" class=\"wp-image-6306\" srcset=\"https:\/\/24hourcares.mgldevs.com\/wp-content\/uploads\/2026\/06\/image-1024x683.png 1024w, https:\/\/24hourcares.mgldevs.com\/wp-content\/uploads\/2026\/06\/image-300x200.png 300w, https:\/\/24hourcares.mgldevs.com\/wp-content\/uploads\/2026\/06\/image-768x512.png 768w, https:\/\/24hourcares.mgldevs.com\/wp-content\/uploads\/2026\/06\/image-18x12.png 18w, https:\/\/24hourcares.mgldevs.com\/wp-content\/uploads\/2026\/06\/image.png 1536w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"wp-block-paragraph\"><em>24 Hour Home Care offers <a href=\"https:\/\/24hourcares.mgldevs.com\/es\/community-supports\/calaim-respite-care\/\" data-type=\"service\" data-id=\"3277\">Atenci\u00f3n de respiro<\/a> and <a href=\"https:\/\/24hourcares.mgldevs.com\/es\/service\/personal-care-homemaker\/\" data-type=\"service\" data-id=\"3294\">Personal Care and Homemaker Services <\/a>as part of our Community Supports Program.<\/em><\/p>\n<\/blockquote>\n\n\n\n<p class=\"wp-block-paragraph\">Community Supports are available to Medi-Cal members regardless of ECM eligibility, although those that qualify for ECM may also utilize Community Supports.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Due to ECM\u2019s focus on Medi-Cal members with high care management needs, it emphasizes the coordination of care through a Lead Care Manager. Community Supports emphasizes the services provided, which are often coordinated by members themselves or someone from their family through their local Regional Center.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How to Refer to CalAIM ECM<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">California uses a &#8220;no wrong door&#8221; approach, meaning anyone\u2014including community-based organizations, social services providers, or the members themselves\u2014can initiate the process of applying for ECM.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Social workers and case managers can refer individuals to CalAIM ECM by submitting a referral to the member\u2019s Medi-Cal managed care plan. The process looks like this:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Identify Eligibility: <\/strong>Confirm the member is enrolled in a Medi-Cal managed care plan and belongs to at least one Population of Focus.<\/li>\n\n\n\n<li><strong>Verify the Health Plan:<\/strong> Use the DHCS Managed Care Plan Directory to find the specific health plan serving the member&#8217;s county.<\/li>\n\n\n\n<li><strong>Complete the Referral Form: <\/strong>Most plans provide standardized Adult or Child\/Youth referral forms on their websites. The form will require the member\u2019s index number (CIN), the specific Population of Focus being addressed, and a brief clinical or social justification for the referral.<\/li>\n\n\n\n<li><strong>Submit the Request: <\/strong>You can submit these forms via the plan\u2019s provider portal (if registered), secure fax, or email. Some plans also accept phone referrals through their Member Services or dedicated CalAIM lines.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">If Your Member Needs Community Supports<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">ECM is designed for members with the most complex cases, while Community Support covers California <strong>seniors who need assistance<\/strong> with daily living to stay in their own home. If you are a care coordinator or social worker and your members needs Community Supports, 24 Hour Home Care can help.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">24 Hour Home Care is one of California&#8217;s leading providers of CalAIM Community Supports, partnering with every major Medi-Cal health plan to deliver in-home personal care and respite services to members across the state.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><a href=\"https:\/\/24hourcares.mgldevs.com\/es\/resource\/what-is-calaim\/\" data-type=\"resource\" data-id=\"6075\">Learn more about CalAIM ><\/a><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What sets us apart is our Agency With Choice model. Rather than assigning an unknown caregiver, we empower families to <strong>select someone their loved one already knows<\/strong>; a family member, neighbor, or trusted friend. We handle everything else: hiring, training, background checks, and payroll. The result is care that feels familiar from day one, which means faster starts, stronger engagement, continuity of care and better outcomes for members.<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"wp-block-paragraph\">&#8220;Rated 4.65 out of 5 stars by members. We partner with California&#8217;s leading Medi-Cal health plans across 58 counties.&#8221;<\/p>\n<\/blockquote>\n\n\n\n<p class=\"wp-block-paragraph\">For care coordinators, working with 24 Hour Home Care means:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Referrals processed quickly:<\/strong> We verify eligibility and manage authorization directly with the health plan<\/li>\n\n\n\n<li><strong>Consistent communication:<\/strong> We work directly with your members, walking them through every step to get care started quickly.<\/li>\n\n\n\n<li><strong>A trusted, established partner<\/strong>: We have years of experience navigating the CalAIM system alongside health plans, care coordinators, members, and families.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">How to Refer<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Referring your member to 24 Hour Home Care for Personal Care and Homemaker Services or Respite Care takes just a few minutes. Here is how it works:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Referral is submitted: <\/strong>A care coordinator, social worker, or health plan submits a referral on the member&#8217;s behalf<\/li>\n\n\n\n<li><strong>Authorization: <\/strong>Our team works directly with the health plan to verify eligibility and secure authorization<\/li>\n\n\n\n<li><strong>Onboarding: <\/strong>We handle hiring, training, background checks, and payroll for the caregiver the family has chosen<\/li>\n\n\n\n<li><strong>Care starts:<\/strong> Care can begin with someone the member already knows and trusts, familiar and consistent from day one<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><em><a href=\"https:\/\/www.24hrcares.com\/csrefer\" data-type=\"link\" data-id=\"www.24hrcares.com\/csrefer\" target=\"_blank\" rel=\"noopener\">Submit a referral ><\/a><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"<p>Enhanced Care Management serves Californians who need the most help in coordinating care, taking a holistic approach to improving health outcomes. Enhanced Care Management (ECM) is a California statewide Medi-Cal benefit designed for members with the most complex medical and social needs. It\u2019s a response to a medical crisis that had been growing for decades. [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"resource-category":[],"service-group":[],"class_list":["post-6305","resource","type-resource","status-publish","format-standard","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/resource\/6305","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/resource"}],"about":[{"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/types\/resource"}],"author":[{"embeddable":true,"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/users\/2"}],"version-history":[{"count":1,"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/resource\/6305\/revisions"}],"predecessor-version":[{"id":6307,"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/resource\/6305\/revisions\/6307"}],"wp:attachment":[{"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/media?parent=6305"}],"wp:term":[{"taxonomy":"resource-category","embeddable":true,"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/resource-category?post=6305"},{"taxonomy":"service-group","embeddable":true,"href":"https:\/\/24hourcares.mgldevs.com\/es\/wp-json\/wp\/v2\/service-group?post=6305"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}