More Than 145,000 Managed Care Members Received Services During The First Full Year Of California Medicaid’s Enhanced Care Management & Community Supports

By OPEN MINDS Circle

In 2022, during the first year of California Medicaid’s (Medi-Cal) Enhanced Care Management (ECM) and Community Supports implementation, more than 145,000 managed care plan (MCP) members received the services. Specifically, 109,004 Medi-Cal MCP members received ECM, and 36,391 received at total of 80,859 Community Supports services, as reported in the “Medi-Cal ECM and Community Supports Calendar Year (CY) 2022 Implementation Report” by the California Department of Health Care Services (DHCS).

ECM

ECM is a statewide MCP benefit that provides person-centered, community-based care management to the highest need members and is the highest care management tier of the Medi-Cal MCP Population Health Management continuum. ECM launched for the first three populations of focus (POFs) in the 25 California counties that previously operated Medi-Cal Whole Person Care (WPC) pilots or the Health Homes Program (HHP) on January 1, 2022. In July 2022, the remaining 33 counties launched ECM for the first three POFs. These last 33 counties did not previously have WPC or HHP.

ECM is provided by community-based provider organizations who have the expertise and experience to address the unique needs of members, which differ across ECM POFs. By the end of 2022, there were 644 unique ECM provider organizations, and approximately 1,158 provider organization contracts.

Medi-Cal members qualified for ECM by meeting the eligibility criteria for at least one POF, and many members meet eligibility criteria for more than one POF. Participating members are assigned a Lead Care Manager who will meet them wherever they are located. In 2022, POFs included only (some members were part of more than one category):

• Adults experiencing homelessness (58,900 members who received ECM)
• Adults at risk for avoidable hospital or emergency department (ED) utilization (42,400 members who received ECM)
• Adults with serious mental health and/or addiction needs (36,100 members received ECM)
• Adults transitioning from incarceration (certain former whole person care counties only – 4,900 members received ECM)

Community Supports

Community Supports are services that address Medi-Cal MCP members’ social drivers of health and help them avoid higher, costlier levels of care. DHCS has pre-approved 14 services that MCPs are encouraged to offer as Community Supports:

1. Housing transition navigation services
2. Housing deposits
3. Housing tenancy and sustaining services
4. Short-term post-hospitalization housing
5. Recuperative care (medical respite)
6. Day habilitation programs
7. Respite services
8. Nursing facility transition/diversion to assisted living facilities
9. Community transition services/nursing facility transition to a home
10. Personal care and homemaker services
11. Environmental accessibility adaptations (home modifications)
12. Medically supportive food/medically tailored meals
13. Sobering centers
14. Asthma remediation

MCPs were not required to provide Community Supports, but every MCP in California has opted to do so. By the end of 2022, every California county had at least two Community Supports available.

For more information, contact: Office of Communications, California Department of Health Care Services, 1501 Capitol Avenue, MS 0000, Post Office Box 997413, Sacramento, California 95899; 916-539-7736; Email: ContactUs@dhcs.ca.gov; Website: https://www.dhcs.ca.gov/