Enhanced Care Management (ECM)
With CalAIM’s Enhanced Care Management (ECM) benefit, extra care coordination services are covered for HPSM’s most at-risk adult Medi-Cal members who are:
- Adults, unaccompanied youth and children, and families experiencing homelessness.
- Adults, youth and children who are at risk for avoidable hospital or emergency department care.
- Adults, youth and children with serious mental health and/or substance use disorder needs.
- Adults living in the community and at risk for long-term care institutionalization.
- Adult nursing facility residents transitioning to the community.
- Children and youth enrolled in California Children's Services (CCS) or CCS Whole Child Model with additional needs beyond their CCS condition(s).
- Children and youth involved in child welfare (foster care).
Each member in ECM has a Care Manager who talks with them as well as their care team. The care team can include their doctors, mental health providers, specialists, pharmacists, case managers, social services providers and others. This makes sure everyone works together to get the member the care they need. A member’s Care Manager can also help them:
- Find doctors and get appointments for health-related services they may need.
- Better understand and keep track of their medications.
- Set up rides to and from health care visits.
- Find and apply for community-based services based on their needs. This includes housing supports or meals to fit health needs.
- Get follow-up care after they leave the hospital.
Frequently asked questions (FAQs) about ECM
How can members get ECM?
There are two ways members can get ECM:
- HPSM offers to enroll members who qualify for ECM based on member health records.
- Members who want to enroll in ECM can call HPSM Member Services at 650-616-2133. If they are not eligible, HPSM can help them find other supports.
How are members informed that they are in ECM?
Members new to ECM services get a letter from HPSM and a call from their ECM provider.
Do members pay for ECM?
No. Eligible members get ECM at no cost.
Does getting ECM services change the benefits members already have?
No. When members enroll in ECM, all their benefits stay the same. ECM just provides extra help to better coordinate members’ care.
Can members opt out of ECM?
Yes. Members can opt out of ECM at any time by telling their ECM Care Manager that they no longer want to be in ECM. Their ECM Care Manager can refer them to other supports if they wish.
Who provides ECM services?
HPSM contracts with the following agencies that provide ECM to members:
- Aging and Adult Services – formerly the Multipurpose Senior Services Program (MSSP)
- Bridges to Wellness
- California Children Services
- Healthcare in Action
- The Institute on Aging
- North East Medical Services
- Upward Health
For details, see HPSM’s list of contracted ECM providers.
Can members choose their ECM provider?
Yes. Members can choose from HPSM’s list of contracted ECM providers. If a member wants to see a specific ECM provider, they should tell their HPSM Care Coordinator. If a member does not choose an ECM provider, HPSM will choose one for them.
Can a member change their ECM provider?
Yes. Members just need to tell their ECM Care Manager they want to change ECM providers. They can also call HPSM Member Services at 650-616-2133 to change.
For more information about Medi-Cal benefits, refer to the Medi-Cal 2023 Member Handbook / Evidence of Coverage. To order a printed Member Handbook, email CustomerSupport@hpsm.org or call Member Services.
Clicking on these links will direct you to a website or document that is external to www.hpsm.org. The Health Plan of San Mateo (HPSM) accepts no responsibility for the content, policies or accessibility of the external websites or external documents linked to on this website.
For more information about Medi-Cal benefits, refer to the Medi-Cal 2023 Member Handbook / Evidence of Coverage. To order a printed Member Handbook, email CustomerSupport@hpsm.org or call Member Services.