Enhanced Care Management (ECM)
With CalAIM’s Enhanced Care Management (ECM) benefit, HPSM covers extra care coordination services for HPSM’s most at-risk adult Medi-Cal members. This includes Medi-Cal members who:
- Do not have stable housing at this time
- Have difficult health issues and have gone to the hospital or emergency department many times over the last six months
- Have a serious mental health condition or struggle with drug or alcohol use
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
Who is eligible for ECM?
ECM benefit is for HPSM’s most at-risk adult Medi-Cal members who:
- Do not have stable housing at this time.
- Have difficult health issues and have gone to the hospital or emergency department many times over the last six months.
- Have a serious mental health condition or struggle with drug or alcohol use.
How can members get ECM?
There are three ways that members can get ECM:
- Members who were enrolled in the Multipurpose Senior Services Program (MSSP) or Whole Person Care (WPC) and Bridges to Wellness (BTW) before January 1, 2022 were automatically enrolled in 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?
There are two ways that members are informed that they are in ECM:
- Members who were enrolled in the programs below were automatically enrolled in ECM. They got a letter that explains what ECM is and who their ECM provider is.
- Multipurpose Senior Services Program (MSSP)
- Community Care Settings Pilot (CCSP)
- Whole Person Care: Bridges to Wellness
- 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 three agencies that provide ECM to our members:
- Aging and Adult Services – formerly the Multipurpose Senior Services Program (MSSP)
- Bridges to Wellness
- The Institute on Aging
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.
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.