Enhanced Care Management (ECM)

Agency: HEALTH PLAN OF SAN JOAQUIN (HPSJ)

Description:

Offers care management services to Medi-Cal Health Plan of San Joaquin members with complex medical and social needs. Provides support to coordinate care between Doctors, Specialists, Pharmacists, Social Services Providers, and HPSJ Members. Also help find and apply for other services in your community.

Services include:

• Regular doctor visits for preventative care when you are sick
• Specialty Care Visits
• Help with housing or shelter
• Behavioral health and mental health services
• Substance use disorder treatment
• Developmental health
• Oral health (dental)
• Long-term services and supports (LTSS)
• Referrals to community resources in your area

Services covered under ECM include:

• Outreach and engagement
• Comprehensive assessment and care management
• Enhanced coordination of care
• Health promotion
• Comprehensive transitional care
• Member and family support services
• Coordination and referral to community and social supports

Phone:

• HPSJ Customer Service Number: 209-942-6320
• State Medi-Cal Health Care Options Number: 800-430-4263
• TTY: 711
• Toll-Free: 888-936-7526 (PLAN)

Website: https://www.hpsj.com/members/calaim/#ECM

Location(s)

Program Delivery

• Eligibility: To qualify, must be an active Medi-Cal Health Plan of San Joaquin member and meet one of the following requirements: • Adults and their Families Experiencing Homelessness • Adults At Risk for Avoidable Hospital or Emergency Department (EDO) Utilization (formerly “High Utilizers) • Adults with Serious Mental Health and/or Substance Use Disorder (SUD) Needs • Individuals Transitioning from Incarceration (some Whole Person Care (WPC) counties) • Adults with Intellectual or Developmental Disabilities (I/DD) • Pregnant or Postpartum Adults • Adults Living in the Community and At Risk for Long Term Care (LTC) Institutionalization • Adults Nursing Facility Residents Transitioning to the Community • Adults without Dependent Children/Youth Living with Them Experiencing Homelessness • Children and Youth Populations of Focus:  Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness  Children and Youth At Risk for Avoidable Hospital or ED Utilization  Children and Youth with Serious Mental Health and/or SUD Needs  Children and Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS Condition  Children and Youth Involved in Child Welfare  Pregnant or Postpartum Youth • Pregnant and Postpartum Individuals At Risk for Adverse Perinatal Outcomes who are subject to racial and ethnic disparities • Individuals Transitioning from Incarceration
• Languages: English
• Application Process: Talk to your health care provider who can find out if you qualify for ECM and when and how you can receive it or call Health Plan of San Joaquin to find out if and when you can receive ECM.
• Program Fees: Free
• Required Documents: Call for information

Service Area

• Defined Coverage Area: San Joaquin County