If you have heard the term Enhanced Care Management and wondered what it actually means for you or someone you love, you are not alone. It is one of the most important programs available to Medi-Cal members in California right now, but it is also one of the least understood. Most people who qualify for it have never heard of it. And many who have heard of it still have questions about how it works, who gets it, and what it actually does in practice.

This article answers the most common questions people have about Enhanced Care Management in plain language, so you can understand whether it applies to your situation and what to do next.

What Is Enhanced Care Management?

Enhanced Care Management, also called ECM, addresses the clinical and non-clinical needs of the highest-need Medi-Cal members through intensive whole-person, community-based care coordination.

In plain language, ECM is a benefit available through Medi-Cal that assigns you a dedicated care manager, a single person whose job is to coordinate all of your health and social needs across every system you interact with. That includes medical care, mental health, substance use services, housing support, and social services.

The goal is to make sure that someone with complex, overlapping needs does not have to figure everything out alone or fall through the gaps between systems that do not talk to each other. Your care manager becomes the person who holds the whole picture together.

Who Qualifies for ECM?

ECM is designed for Medi-Cal members with the most complex needs. It is available to specific groups called Populations of Focus. These include:

• Adults, children, youth, and families experiencing homelessness
• Adults and children with or at risk for avoidable emergency department and hospital visits
• Adults and children diagnosed with serious mental illness or substance use disorder
• Adults living in the community who are at risk of being placed in a nursing home or long-term care facility
• Adults transitioning out of nursing facilities back into the community
• Adults and children with intellectual and developmental disabilities who also qualify under another ECM population
• Justice-involved individuals transitioning from incarceration

The justice-involved population of focus went live January 1, 2024. Members do not need to have received pre-release services to be eligible for this population of focus if they meet the eligibility criteria, for example if they were released from a correctional facility prior to the go-live of pre-release services.

If you or someone you know falls into any of these categories and is enrolled in Medi-Cal, there is a strong chance ECM is available to you.

Does It Cost Anything?

No. ECM is a Medi-Cal benefit available at no cost to eligible members. You do not pay a copay, a monthly fee, or anything else to receive ECM services. It is fully covered through your Medi-Cal managed care plan, which in Solano County includes Partnership HealthPlan and Kaiser.

Can Someone With Both Medi-Cal and Medicare Get ECM?

Yes. Members with Medi-Cal and other health coverage such as Medicare who meet the ECM eligibility criteria are eligible to receive ECM. Having Medicare in addition to Medi-Cal does not disqualify you from ECM. What matters is whether you meet the eligibility criteria based on your needs and situation.

What Does a Care Manager Actually Do?

This is one of the most important questions to answer clearly, because the care manager is the heart of what makes ECM different from other programs.

Your care manager is a single dedicated person who:

• Conducts a comprehensive assessment of your health, mental health, housing, social, and practical needs
• Develops an individualized care plan based on that assessment
• Coordinates your care across every provider and system involved in your life, including doctors, mental health providers, housing programs, and social services
• Helps you schedule and keep appointments
• Follows up to make sure referrals actually connect
• Provides health education and self-management support
• Assists with transitions, such as coming home from a hospital, leaving incarceration, or moving into new housing
• Advocates for you within systems that can be difficult to navigate alone
• Connects you to community resources and social supports

As we covered in the article on Need Help Navigating Medi-Cal in Solano County? How ECM Helps, the care manager meets you wherever you are, at home, in a shelter, at a clinic, or in the community. You do not have to come to an office to receive support.

How Is ECM Different From Regular Case Management?

This is a common source of confusion. Regular case management, the kind many people have encountered through county agencies or social services, typically involves a worker managing a large caseload who connects clients to services and monitors compliance with program requirements.

ECM is more intensive and more holistic than that. The key differences are:

• Lower caseloads: ECM care managers carry significantly fewer clients than typical case managers, which allows for more frequent and more meaningful contact.
• Whole-person focus: ECM addresses health, mental health, housing, and social needs together rather than treating each in isolation.
• Community-based delivery: ECM meets people where they are rather than requiring them to come to an office.
• No compliance requirement: ECM is not a program you have to perform for. Your care manager is working for you, not monitoring you for compliance with external requirements.
• Coordination across systems: ECM is specifically designed to bridge the gaps between healthcare, behavioral health, housing, and social services, which traditional case management rarely does effectively.

How Does Someone Get Referred to ECM?

There are several ways to get connected to ECM services. A referral can come from:

• A doctor, nurse, or other healthcare provider
• A hospital discharge planner
• A mental health provider
• A social worker or county agency
• A community organization like Solano Impact Care
• A Medi-Cal managed care plan reaching out directly to an eligible member

You can also reach out directly to an ECM provider in your area to ask about eligibility. You do not need a formal referral from a doctor to start the conversation. If you are in Solano County and think you or someone you know may qualify, contacting Solano Impact Care directly is one of the fastest ways to find out.

Managed care plans are encouraged to coordinate with shelters, homeless services providers, recuperative care providers, community partners, and other service providers to receive direct referrals. This means community organizations embedded in local networks are often the first point of contact for people who would otherwise not know ECM exists.

Can a Person Choose Their ECM Provider?

ECM providers may serve one or more of the ECM target populations or a subset of target populations with which they have experience and expertise. Different providers specialize in serving different populations, which means choosing a provider that has specific experience with your situation matters.

For residents of Solano County dealing with homelessness, incarceration history, substance use recovery, or mental health challenges, Solano Impact Care is a provider whose team has lived experience with those exact circumstances. That is not a minor detail. As we discussed in the article on Why Solano Impact Care Is Different: Experience-Driven Community Care, a care manager who has personally navigated what you are navigating brings a level of understanding and trust-building that clinical training alone cannot replicate.

What Happens at the First ECM Appointment?

The first step after being connected to ECM is a comprehensive assessment. This is a detailed conversation between you and your care manager designed to understand your full situation, not just your medical needs but your housing situation, your social supports, your mental health, your recovery status if applicable, your practical barriers, and your goals.

The assessment is not an interrogation. It is the foundation of a care plan that is built around your specific needs and circumstances. A good care manager approaches it with genuine curiosity and without judgment, which is particularly important for people who have had difficult experiences with institutions and systems in the past.

After the assessment, your care manager develops a care plan with you, not for you. The plan outlines your goals, the services and supports that will help you reach them, and the steps involved. It is a living document that gets updated as your situation changes.

How Long Does ECM Last?

ECM is not a time-limited program with a fixed end date. It continues for as long as a member meets the eligibility criteria and is benefiting from the services. As your situation stabilizes and your needs change, the intensity of ECM support can be adjusted accordingly.

The goal of ECM is not to create permanent dependency on a care manager. It is to help you build the stability, connections, and skills that allow you to navigate your own life with less intensive support over time. Transition out of ECM happens gradually and with planning, not abruptly.

Does ECM Cover Mental Health and Substance Use Support?

ECM does not directly provide mental health therapy or substance use treatment. What it does is coordinate access to those services. Your care manager can help you identify the right mental health or substance use provider, navigate the process of getting connected, manage the coordination between that provider and your other care, and follow up to make sure the connection actually holds.

For people dealing with dual diagnosis, which we covered in detail in the article on What Is Dual Diagnosis and How Is It Treated?, this coordination function is particularly important. Managing both a mental health condition and a substance use disorder across multiple providers and systems is exactly the kind of complexity that ECM was designed to address.

What If Someone Is Not Currently Housed?

ECM is specifically designed to serve people experiencing homelessness. ECM is available to adults, children, youth, and families experiencing homelessness as one of its core populations of focus. Not having a fixed address does not disqualify someone from ECM. Care managers can meet members at shelters, on the street, at community organizations, or wherever they currently are.

In Solano County, Solano Impact Care can connect eligible members who are experiencing homelessness to both ECM services and the housing-related Community Supports that work alongside ECM to address housing instability directly. For women who need transitional housing as part of that stability plan, Hazel’s Tranquility Place in Vallejo provides a structured, supportive residential environment specifically for women reentering the community from incarceration or recovering from substance use. Founded in 2019 by K. Patrice Williams after she witnessed the gaps in housing and support for women and children in Solano County during her campaign for Solano County Supervisor, Hazel’s Tranquility Place offers exactly the kind of safe foundation that makes ECM engagement possible. Learn more at hazelstranquility.org.

Is ECM Available in Solano County Right Now?

Yes. ECM is available in Solano County through Partnership HealthPlan and Kaiser for eligible Medi-Cal members. CalAIM produced two flagship benefits, Enhanced Care Management and Community Supports, and the benefits are available through the Medi-Cal managed care plan a member already has.

Solano Impact Care provides ECM services in Solano County and is actively enrolling eligible members. Their team is made up of people with lived experience navigating homelessness, incarceration, substance use, and mental health challenges, which means the care coordination they provide is grounded in authentic understanding of the barriers their clients face.

How Do You Get Started?

If you think you or someone you love may qualify for ECM in Solano County, the starting point is a conversation. You do not need to have everything figured out before you reach out. You do not need to know exactly which services you need. You just need to make the first contact.

Solano Impact Care can assess your eligibility, answer questions specific to your situation, and walk you through what ECM would look like for you or your family member. They serve Medi-Cal members across Solano County including Vallejo, Fairfield, Vacaville, Dixon, Suisun City, and Rio Vista.

Call (707) 301-4051 or email care@solanoimpactcare.org to get started. ECM is available now, it costs nothing, and it was built specifically for people carrying the kind of complexity that no one should have to navigate alone.