What Enhanced Care Management in Medi-Cal is and who can get it

This page is general information, not legal or medical advice. Do Not Lose Hope is not part of Medi-Cal or any health plan.

What is Enhanced Care Management?

ECM is a Medi-Cal benefit for members with complex needs. If you qualify, you get one lead care manager: your main contact who works with you and coordinates your health care and the services around it.

Your care manager can help:

• Reach out to you and keep in touch, mostly in person where you live or get care
• Do a full check of your needs and make a care plan with you
• Coordinate your doctors, mental health care, substance use treatment and medicines
• Teach you about your health and help you reach your goals
• Help you move safely from the hospital, jail or a nursing home back home
• Support you and your family or caregivers
• Connect you to community help like housing, food and transportation

Those are the seven parts of ECM that the state Department of Health Care Services (DHCS) requires plans to cover. Phone or video visits can be used when in person contact doesn't work for you.

Who can get ECM?

ECM is only for members who are enrolled in a Medi-Cal managed care health plan and who fit at least one "Population of Focus." DHCS updated these groups in January 2026. In plain words:

Adults (21 and older) may qualify if they:

• Are experiencing homelessness, or will lose housing within 30 days, and have a complex physical, mental health or developmental need. Families experiencing homelessness count too.
• Use the ER or hospital a lot in ways that might be avoided: for example 5 or more ER visits in 6 months, or 3 or more unplanned hospital or short nursing stays in 6 months.
• Have serious mental health or substance use needs, qualify for county specialty services, and face added risks like frequent ER visits, a high risk of overdose or suicide, or a social challenge such as unstable housing.
• Were released from jail or prison in the past 12 months and have a qualifying health condition.
• Need a nursing home level of care but want to stay home with support, or live in a nursing home and want to move back to the community.
• Are pregnant or up to 12 months postpartum and belong to a group that faces higher rates of serious problems or death in pregnancy, based on California public health data. This is called the Birth Equity group.

Children and youth (under 21) may qualify if they:

• Are experiencing homelessness or unstable housing, including living in a motel, shelter or doubled up
• Have frequent ER visits or hospital stays that might be avoided (for example 3 or more ER visits in 12 months)
• Qualify for county specialty mental health or substance use services
• Are leaving a youth facility, jail or prison in the past 12 months (former foster youth up to age 26 included)
• Are in California Children's Services (CCS) and face at least one serious social challenge
• Are or were in foster care or involved with child welfare, with some age limits
• Are pregnant or postpartum in the Birth Equity group

Your plan decides if you qualify. If you are not sure, ask anyway. The plan can check.

How do I ask for ECM?

You can ask yourself. DHCS says members and their families may self refer. Your doctor, clinic, county worker, hospital, In Home Supportive Services provider or others can refer you too.

1. Find your plan. It is on your Medi-Cal plan card. In San Mateo County, the plan is Health Plan of San Mateo. In Santa Clara County, it is Santa Clara Family Health Plan or Kaiser Permanente. In any other county, look up your plan on the DHCS plan contact list.
2. Call Member Services and ask to be assessed for ECM. Use the script below.
3. Tell them why. Name what is hard: ER visits, a recent hospital stay, mental health care, losing housing, leaving jail, a high risk pregnancy, a child in foster care.
4. Ask your doctor or clinic to send a referral. In San Mateo County, providers send a referral form to HPSM. HPSM says it decides within five working days for routine referrals and within 72 hours for urgent ones.
5. Write down the date, the name of the person you spoke with and any reference number.

For San Mateo County residents, HPSM lists ECM providers including Ravenswood Family Health Network in East Palo Alto (650-330-7400), Healthcare in Action in Redwood City (650-442-1569), Bridges to Wellness in South San Francisco (650-573-4799) and Upward Health in San Mateo (650-955-7915).

Does it cost anything?

No. ECM is part of your Medi-Cal benefits. San Francisco Health Plan, a Medi-Cal plan, says members get ECM at no cost (checked October 21, 2026). HPSM says calls to Member Services are free. If anyone asks you to pay for ECM, stop and call your plan or the Ombudsman at (888) 452-8609.

Do I have to say yes?

No. HPSM says members choose whether they want these services, and DHCS rules expect plans to respect member choice. If you say no, your plan should still look at whether another program fits you.

What is the difference between ECM and Community Supports?

ECM is the care manager who coordinates everything. Community Supports are extra services that Medi-Cal plans offer, such as help with housing. A care manager can help you ask for them. Ask your plan which Community Supports it offers in your county.

What changes on January 1, 2027?

This is important for many immigrant families.

Starting January 1, 2027, DHCS will move these members out of managed care health plans into Fee for Service (FFS) Medi-Cal, at every age, including children and pregnant members (DHCS FFS transition page, updated October 14, 2026):

• People who are undocumented
• Green card holders in the five year waiting period for federal Medicaid
• People "Permanently Residing in the U.S. Under Color of Law" (PRUCOL). DHCS lists deferred action, including DACA, under PRUCOL, so this includes people with DACA.

This changes how you get care, not whether you keep Medi-Cal. ECM and Community Supports will not continue under FFS Medi-Cal, because they are only offered through health plans.

What does continue:

• Specialty mental health and substance use treatment through county behavioral health plans
• Medicines through Medi-Cal Rx
• Community Health Worker services (health education, finding resources, help renewing Medi-Cal), chronic care management for conditions like asthma or diabetes, and doula care
• Any doctor or clinic that accepts FFS Medi-Cal
• The Medi-Cal Help Line, 1-800-541-5555, for help finding providers (checked October 21, 2026)

DHCS's Medi-Cal changes page also said on October 19, 2026 that it plans a nurse advice line and community navigators, with details before the change. If you are in ECM now and this applies to you:

• Ask your care manager now to help you finish big tasks before January 1, 2027: housing applications, specialist referrals, medicine plans.
• Ask for a written plan for after the change, including your county behavioral health contacts.
• Renew Medi-Cal on time. Missing a renewal can mean losing full Medi-Cal. See Medi-Cal for adults in 2026.

What if my plan says no?

• Ask for the decision in writing, with the reason.
• Ask your doctor or clinic to send a referral with more details about your needs.
• Ask the plan how to file an appeal and by what date, and do it quickly.
• If you are stuck, call the Medi-Cal Managed Care Ombudsman at (888) 452-8609.
• Disability Rights California can help people with disabilities: (800) 776-5746, TTY (800) 719-5798.

For step by step appeal help, see How to complain or appeal when Medi-Cal mental health or addiction care is denied.

What mistakes should I avoid?

• Waiting for someone to offer it. Ask.
• Giving up after one call. Ask for a supervisor or call your doctor's office for a referral.
• Missing calls after you ask. Your plan or an ECM team may call you. Answer or call back.
• Letting your Medi-Cal renewal lapse. ECM ends if your Medi-Cal plan ends.

Common questions

I have Medi-Cal and Medicare. Can I get ECM? DHCS updated its rules for people with both in September 2026. Ask your plan.

My plan has its own care manager already. Is that ECM? Not always. Plans have other care management programs too. Ask, "Is this Enhanced Care Management?"

Can my care manager help with housing? Yes, coordination with housing help is part of ECM. Your care manager can also connect you to Community Supports and other services.

Can I get ECM for my child? Yes, if your child is enrolled in a Medi-Cal plan and fits a children and youth group.

What if I live outside San Mateo and Santa Clara counties? The ECM rules on this page are statewide. Call the Member Services number on your plan card, or find it on the DHCS plan contact list. Your county's mental health plan number is on the DHCS county list.

Is my information shared with immigration? See Mental health care without fear, which explains what DHCS has said about Medi-Cal data.

Who can help?

Contact them to confirm hours, languages and openings. Being listed here is not a referral or a promise of service. Local numbers are for San Mateo County and Santa Clara County residents; the Ombudsman and Help Line serve all of California.

• Medi-Cal Help Line (statewide): 1-800-541-5555
• Health Plan of San Mateo Member Services: 650-616-2133 or 1-800-750-4776
• HPSM care coordination: 650-616-2060
• Santa Clara Family Health Plan Customer Service: 800-260-2055
• Kaiser Permanente Medi-Cal Member Services: 855-839-7613
• Ravenswood Family Health Network: 650-330-7400
• Medi-Cal Managed Care Ombudsman: (888) 452-8609
• San Mateo County ACCESS Call Center (mental health and substance use): (800) 686-0101, 24/7
• Santa Clara County Behavioral Health Call Center: (800) 704-0900, press 1, 24/7

Is there a script I can print?

Yes. Keep it by the phone.

You don't have to hold all of this together by yourself. Asking for help is a strong step, and you deserve a team in your corner.