Children and youth with significant health and social needs often have to navigate multiple systems just to get what they need. This fragmentation adds burden on parents, caregivers, and other case managers and social workers trying to ensure kids don’t fall through the cracks.  

Fortunately, a new Medi-Cal benefit called Enhanced Care Management (ECM) aims to make accessing care a lot smoother for some of the most vulnerable populations of kids in the state (along with other groups), by coordinating their care across service providers and delivery systems.  

What does this new benefit mean for children and youth in practice?  

Care coordination through the ECM benefit intends to be “whole person care” that cuts through jurisdictional silos and lessens the barriers to care that prevent some of the most vulnerable children from accessing what they need and are entitled to.  

ECM has the potential to mean the burden does not fully fall on parents or caregivers to navigate the complex world of provider prescriptions, insurance approvals, pharmacy benefit processes, medical equipment vendors, and community providers just to get life-saving care for their kids. In one case, Sarah, a two-year old with autism and other social needs, was enrolled in ECM when a care manager was able to connect and build trust with Sarah’s mother after multiple attempts to reach her on the phone and in person. Ultimately, once Sarah was enrolled in ECM services, the ECM care manager facilitated moving Sarah and her mom into a more secure apartment, connected them to food pantry services, and helped find Sarah timely appointments with a specialized autism therapist. These are the types of coordinated services that can support the holistic well-being of children and families when they need it. 

Alongside the stories of success, however, there are also ones of struggle. As one parent of a child with complex medical needs put it at a recent panel sponsored by Family Voices of California: “I just want it to work. I just want the goods and services to be delivered so that he can live the life he needs to live.” She emphasized that she believes in the potential of ECM to relieve parents of some of the care navigation burden. However, an ECM care manager was unable to find formula for her son’s enteral feeding tube, demonstrating just how hard it can be to navigate fragmented systems.  

The new ECM benefit is also critically important for making sure children and youth in foster care don’t fall through the system gaps when they move across county lines and provider networks, but still need stable access to care. One public health nurse was pleasantly surprised to get help for a child in foster care coming from another county due to ECM coordination; usually, care would get denied or they would encounter some other red tape that delayed it. Historically, it has been challenging for children involved in the child welfare system to access services if they move neighborhoods and counties, but ECM services could change that. 

More must be done for kids to have coordinated care. 

Since ECM went live for most children and youth populations about 10 months ago, over 6,300 kids have enrolled, the majority of which (58%) live in San Diego and Los Angeles counties. However, overall enrollment in ECM is troublingly low. For example:  

• Less than 2% of eligible foster children are enrolled in ECM, despite the fact that all foster youth in Medi-Cal managed care are eligible.  

• Only about 0.49% of eligible children with certain diseases or health problems in the California Children’s Services (CCS) program are receiving the new ECM benefit.  

Click here for a summary of ECM enrollment data for children and youth populations. 

It is clear that the ECM model was designed for the adult population, and applying an adult-focused benefit to pediatric populations has been challenging. Pediatric providers have pointed out that there are different rules, goals, and interventions when it comes to children’s health, and there are unique case navigation needs for children and youth when taking into account developmental milestones, family dynamics, and existing programs. These challenges are further compounded for children and youth involved in the child welfare system who often move frequently and have additional unique needs. These differences have made it difficult for ECM providers and services to effectively reach children and youth.   

More must be done to make sure that eligible Medi-Cal members know about the ECM benefit and understand its potential value so that they can enroll in ECM services [see box below]. It is, after all, understandable that families would be skeptical of being contacted from unknown phone numbers or unfamiliar agencies about a new service for their child that they’ve never heard of before.  

At the same time, more needs to be done by the state and health plans to make sure that there is a qualified network of ECM providers/care managers that can meet the unique developmental, health, and social needs of children and youth. To do this, the state and health plans need to engage and recruit more qualified ECM providers and reduce the barriers that make it hard for community-based organizations to provide enhanced services to Medi-Cal families they are already serving. The state must also do a better job of engaging with families and providers to develop meaningful outcome measures for tracking successful implementation of the ECM benefit and its impact in promoting equitable child health outcomes. Only then will the ECM benefit fully reach its potential of helping the kids who can benefit from enhanced management of their care.