HEALTHmattersMD

Welcome to the HEALTHmattersMD blog—an online resource where providers can find the latest news and updates about HPSM. Top stories are highlighted with images, and you can find more stories listed under them. To read a story, just click the headline or the "Read more" link. In the side menu, you can also select articles by topic or see our newsletter archive and provider notices.

Top Stories

NCQA-4-star-accredited

Enhanced Care Management Expanded to Children and Youth

Learn how this CalAIM program gets our most at-risk young Medi-Cal members the care they need to be healthy.

digital newsletter

Enhanced Care Management Expanded to Children and Youth

Learn how this CalAIM program gets our most at-risk young Medi-Cal members the care they need to be healthy.

DON'T LOSE YOUR MEDI-CAL

Enhanced Care Management Expanded to Children and Youth

Learn how this CalAIM program gets our most at-risk young Medi-Cal members the care they need to be healthy.

More stories

Enhanced Care Management Expanded to Children and Youth

In 2022, the Department of Health Care Services (DHCS) launched the statewide CalAIM program. This has enabled health plans like HPSM to cover new types of care for the highest-need Medi-Cal members. 

One of our first offerings was Enhanced Care Management (ECM) for the most at-risk adult Medi-Cal members. This high-touch model of care includes in-person services provided by a Care Manager who works closely with the member and their care team to address both medical and social needs. The Care Manager can help the member find doctors, get community-based services for housing or meals and much more.

Starting on July 1, 2023, we expanded ECM to children and youth Medi-Cal members who are:

  • Experiencing homelessness.
  • Struggling with serious mental health or substance use issues.
  • Often hospitalized or in the emergency room.
  • Enrolled in California Children’s Services (CCS) and have complex social needs.
  • In the child welfare system. 

The extra care coordination provided by ECM will ensure these children and youth get all the care they need to stay healthy. HPSM contracts with California Children’s Services to provide ECM services for this population. A complete listing of all our current providers and the populations of focus they serve can be found on our Enhanced Care Management and Community Supports Provider List and Authorization Tips page.  

HPSM members are informed that they are authorized for ECM with a letter from HPSM and a phone call from their ECM provider. If you believe any of your patients could benefit from ECM and they are not already enrolled in this program, you can find out if they are eligible by visiting our website and clicking the “Eligibility Details” button. If they are eligible, you can submit a prior authorization for services to HPSM

Learn more about HPSM’s CalAIM initiatives.