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.