Navigating the health care system can be difficult—especially for individuals facing multiple health challenges, housing instability, mental health needs, or barriers to accessing care. For many Medi-Cal members in California, Расширенное управление уходом (ECM) offers a powerful solution.

Расширенное управление уходом Medi-Cal is designed to provide care management for complex health needs, helping people access medical care, behavioral health services, and essential community resources. Through a coordinated and patient-centered care approach, ECM helps individuals receive the support they need to improve their health and stability.

For community-based organizations, health care providers, and family members who support Medi-Cal beneficiaries, understanding what Enhanced Care Management is and how Lead Care Managers help members can make it easier to connect people with the right services.

What is enhanced care management?

Enhanced Care Management (ECM) is a Medi-Cal care management program that supports individuals with complex medical, behavioral health, or social needs. It is part of California’s broader effort to improve health outcomes through whole-person care in Medi-Cal, addressing both health care and the social determinants of health that influence well-being.

Many people struggle with more than just a medical condition. Challenges such as homelessness, transportation barriers, food insecurity, mental health needs, or difficulty navigating health insurance systems can make it hard to manage health conditions effectively.

That’s where enhanced care management comes in.

Through community-based care coordination, ECM connects people with:

• Medical providers and specialists
• Mental health and substance abuse treatment
• Housing and health support resources
• Transportation and community services
• Medication management support
• Follow-up care after hospital visits

These support services for Medi-Cal members are designed to improve health outcomes by addressing the full range of factors that impact a person’s health.

Who qualifies for enhanced care management?

Many people ask: who qualifies for enhanced care management?

ECM services are designed for Medi-Cal members with complex health needs or who face challenges accessing care. Individuals who may benefit from ECM services Medi-Cal include those who:

• Experience homelessness or unstable housing
• Frequently visit the emergency department or are hospitalized
• Live with chronic diseases such as asthma or other ongoing health conditions
• Have mental health or substance abuse disorders
• Are transitioning from prison or incarceration
• Live in or are transitioning from a nursing home or nursing facility
• Are youth involved in foster care
• Need help navigating multiple health care providers and services

In many cases, these individuals face significant risk factors tied to social determinants of health, including limited access to housing, transportation, language support, or health care information. For pregnant and postpartum members, this support is especially important.

Birth equity is a priority within ECM. Black and Indigenous birthing people face significantly higher rates of maternal complications, often due to systemic barriers in the health care system. ECM helps address this by connecting members with culturally responsive prenatal care, doula services, postpartum mental health resources, and community support that makes a real difference.

Through ECM, these members receive care management for complex health needs and ongoing support to help them stay healthy and connected to care.

What does a Lead Care Manager do?

A key part of Enhanced Care Management Medi-Cal is the role of the ECM Lead Care Manager.

An ECM Lead Care Manager acts as a single point of contact for the member and helps coordinate services across the health care system. Instead of navigating multiple providers alone, members have someone who helps ensure their care is organized and accessible.

Lead Care Managers support members by:

• Developing a personalized care management plan
• Coordinating appointments with doctors and specialists
• Supporting behavioral health coordination
• Helping members understand medications and treatment plans
• Connecting members to community supports and resources
• Assisting with transportation or appointment scheduling
• Helping members transition after hospital or emergency department visits
• Communicating with providers to ensure everyone is aligned

This type of community health care coordination helps reduce unnecessary hospital visits, improves communication between providers, and helps members stay engaged in their care.

Why does whole-person care matter?

Traditional health care often focuses only on treating a disease or injury. However, whole person care Medi-Cal recognizes that health is influenced by many different factors.

These factors—known as the social determinants of health—include:

• Housing stability
• Food security
• Access to transportation
• Mental health services
• Language accessibility
• Community support networks

When these factors are not addressed, even the best medical treatment may not lead to better health outcomes.

Through community-based care coordination, ECM providers help members connect to resources that support both their health and their daily lives.

For example, a person with asthma may continue visiting the emergency department if they lack stable housing or cannot access medications. By addressing housing and health support, ECM care managers can help reduce health risks and improve long-term outcomes.

How ECM supports providers and organizations

For health care providers, social service agencies, and community-based organizations, ECM programs provide a valuable partnership.

Providers often see patients who struggle to follow treatment plans due to complex social or medical challenges. By referring these individuals to Enhanced Care Management Medi-Cal, providers can connect them with additional support through Medi-Cal care coordination services.

ECM providers help bridge gaps between:

• Hospitals and primary care providers
• Behavioral health providers
• Community-based organizations
• Social service agencies
• Housing and community support programs

This community health care coordination ensures that patients receive comprehensive support across systems.

Organizations working with individuals experiencing homelessness, foster youth, or individuals transitioning from incarceration can also benefit from referring clients to ECM. These programs provide support for people with complex health needs, improving both health outcomes and stability.

How Pacific Health Group offers support

At Pacific Health Group, ECM services are built around the principles of patient-centered care and respectful, compassionate support.

Our Lead Care Managers work directly with members to understand their needs, goals, and priorities. Instead of a one-size-fits-all approach, care plans are tailored to each individual.

Pacific Health Group helps members:

• Navigate Medi-Cal and health insurance services
• Coordinate physical health, mental health, and substance use care
• Access community resources and benefits
• Receive support after hospitalizations or emergency department visits
• Connect with housing, transportation, and food programs
• Build long-term stability and improved health outcomes

Through community-based care coordination, Pacific Health Group works closely with doctors, hospitals, behavioral health providers, and community organizations to ensure members receive the support they need.

Don’t have insurance? If you or someone you know is uninsured but would benefit from enhanced care management, Pacific Health Group can help! We help you apply to Medi-Cal so you can get the services you need!

Get connected with Pacific Health Group

Enhanced Care Management is designed to make health care more accessible, coordinated, and supportive for Medi-Cal members with complex needs.

For community partners, family members, and providers, referring individuals to ECM can help ensure they receive comprehensive care management, community supports, and personalized guidance through the health care system.

To learn more about Enhanced Care Management Medi-Cal or to refer someone for services, call Pacific Health Group at (888) 341-4449 or visit www.mypacifichealth.com.

Our team is here to help connect members with the care, resources, and support they need to improve their health and well-being.