Enhanced Care Management (ECM) Benefit for Children and Youth Populations
Enhanced Care Management (ECM) is a new Medi-Cal benefit to better support populations of children and youth with complex clinical and non-clinical needs who access care in multiple delivery systems. It is available to eligible Medi-Cal Managed Care Plan (MCP) members in all California counties to support comprehensive care management for their complex needs. Through ECM, children will have a single Lead Care Manager based in the community who will coordinate care and services among the physical, behavioral, dental, developmental, and social services delivery systems, making it easier for kids to get the right care at the right time.
ECM is also free! There is no added cost to families for ECM.
“For ECM to be effective, it is not one size fits all. Where we are most successful is where we are building on deep, local expertise and knowledge.”
– Dr. Palav Babaria, Chief Quality Officer and Deputy Director of Quality and Population Health Management at the Department of Health Care Services
Quick Links
Information for Families and Communities
Information for Policymakers and Health Plans
What to Know About ECM:
With ECM, a dedicated Lead Care Manager will coordinate health and health-related services, offering care on the phone, in-person, and/or where members live.
Note that ECM does not replace:
- A member’s benefits: It’s an additional benefit for Medi-Cal members
- A member’s doctors: Members keep their current doctors and other providers
- A member’s options: ECM is voluntary and members can cancel ECM at any time
A Lead Care Manager can help families:
Find doctors and make appointments
Connect families with local resources and Community Supports for food, housing and other social services
Check on prescriptions and help get refills
Arrange free transportation to and from appointments
Who is Eligible for ECM?
To be eligible for ECM services, an individual must be enrolled in a Medi-Cal Managed Care Plan and meet criteria for defined population categories listed in the chart below.
Note: Medi-Cal members eligible for ECM can be referred to as individual/families, patients, clients, or members. This page uses the terms interchangeably.
| Population of Focus | Children & Youth | Adults | |
|---|---|---|---|
| 1 | Individuals Experiencing Homelessness | ✔ | ✔ |
| 2 | Individuals At Risk for Avoidable Hospital or Emergency Department utilization | ✔ | ✔ |
| 3 | Individuals with Serious Mental Health and/or Substance Use Disorder Needs | ✔ | ✔ |
| 4 | Individuals Transitioning from Incarceration | ✔ | ✔ |
| 5 | Adults Living in the Community and At Risk for Long Term Care Institutionalization | ||
| 6 | Adult Nursing Facility Residents Transitioning to the Community | ✔ | |
| 7 | Children and Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS Condition | ✔ | |
| 8 | Children and Youth Involved in Child Welfare | ✔ | |
| 9 | Birth Equity Population of Focus | ✔ | ✔ |
Community Feedback Welcomed
Are you a parent, provider, Community Health Worker, health plan representative, or member with a story to share about Enhanced Care Management?
While Children Now cannot provide case-specific assistance, community feedback is crucial for informing policy changes and ECM implementation. We will communicate these stories and insights with other advocates and state agency officials, and provide resources where possible. If you would prefer to remain anonymous, please omit contact info.
Resource available!
Parent Care Coordination Factsheet (English) (Spanish) (Chinese)
- ECM Provider Toolkit
- ECM Outreach Toolkit
- DHCS ECM for Children and Youth Populations of Focus Spotlight
- ECM and Community Supports Policy Cheat Sheet
- Providing Access and Transforming Health (PATH): Enables California community-based organizations (CBOs), public hospitals, county agencies, Medi-Cal Tribal and designees of Indian Health Programs, and others to successfully participate in the Medi-Cal delivery system as California widely implements Enhanced Care Management (ECM) and Community Supports and Justice Involved services under CalAIM. Interested providers may find the Providing Access and Transforming Health (PATH) Funding and Engagement Benefits Guide helpful.
Referrals for ECM services
The state wants all stakeholders to help spread the word about ECM and how it can benefit children and youth. Community members and health providers that already have a trusted relationship with families can refer individuals to their Medi-Cal Managed Care Plan for ECM services. This means that Medi-Cal members can be referred for ECM in a variety of ways, including:
- Clinical settings, such as primary care and specialty care clinics, hospitals, and county-based Behavioral Health
- Community-based organizations
- Local public health departments and programs
- Educational settings like schools and child care centers
- Regional Centers
- Housing agencies
- Medi-Cal members (a self-referral) or their family members
- Medi-Cal Managed Care Plans
DHCS is streamlining and improving access to ECM by standardizing referrals and expediting the authorization process, policies that will take effect on January 1, 2025. For now, referrals for ECM are best directed to/through Medi-Cal Managed Care Plans (find Managed Care Plans for each county in this directory).
A Review of the Early Experience with ECM Implementation
Children Now undertook this project to research, explore, and better understand the early implementation experience of the ECM benefit for children and youth, as of Summer/Fall 2024. This project has been informed by a number of activities prior to the launch of the ECM benefit for children and youth, and throughout the first year-plus of implementation, including dozens of stakeholder interviews. See the sections below for our findings, observations, and recommendations. (Read more about the activities that informed this project here.)
The ECM benefit originally launched in 2022, and was expanded to children and youth in July 2023. Uptake has been slow – so far, only about 12,000 children and youth statewide are enrolled in the ECM benefit. The available data during the last half of 2023 shows that:
- The Children and Youth with BH/SUD Needs “Population of Focus” (POF) has the highest enrollment of over 4,600 children and youth.
- Not all Children and Youth POFs are growing unequally: for example, Children and Youth Involved in Child Welfare POF grew by 360%, whereas the Children and Youth Experiencing Homelessness POF grew by just 72%.
- In terms of raw numbers, the Children and Youth at Risk for Avoidable ED POF grew the most, by over 2,200 children.
- Only 1,250 kids are enrolled in the Children and Youth Enrolled in California Children’s Services (CCS) POF (up 150 percent from initial enrollment of 501), although roughly 95,000 children/youth in CCS are estimated to be eligible for ECM.
Even though the number of children and youth roughly doubled (from 6,339 to 12,077) during the initial implementation of ECM for children and youth, the ECM provider network for children and youth grew by only 4 percent (from 1301 unique providers to 1357) during the same time. As a result, provider-to-enrollee ratios decreased across all children and youth POFs, meaning there were fewer providers overall relative to the number of children seeking services. Read the full summary of our initial look at ECM data here, and our most recent update here.
As mentioned above, MCPs are expected to contract with a variety of community providers to establish a qualified ECM network to serve their members. Some community ECM providers may also be delivering Community Supports services or may have a strong care coordination background, but others may not. MCPs had time and incentives to build up ECM provider networks before the launch of the ECM benefit for children and youth populations in July 2023. However, contracting processes can be lengthy and provider networks do not necessarily reflect actual access to providers, especially providers with the right skills and competencies. MCP efforts to recruit and contract with qualified ECM providers to serve the unique needs of children and youth are still ongoing.
To better understand the robustness of ECM provider networks for children and youth, we reviewed MCP provider directories in August 2024. Although MCPs’ network directories must indicate which specific Population(s) of Focus each contracted ECM Provider is equipped to serve, several directories used symbols and legends inconsistently, making them difficult to navigate and interpret (i.e. not differentiating symbols for children and adults). A few MCPs had provider directories that were too difficult to analyze or were inaccessible due to broken links. In total, we reviewed 44 MCP provider directories and found just over 860 providers listed who explicitly serve children and youth. Of those child- & youth-serving ECM providers, roughly half (453) report serving children with medical complexity that are in the California Children’s Services (CCS) program. Of particular concern, there were two MCPs – Cal Viva (in Fresno, Kings, Madera counties) and Health Plan of San Mateo (in San Mateo and Santa Clara counties) – that appear to have no ECM providers for children enrolled in CCS listed in their directories. Community Health Group (in San Diego County) has the most ECM providers for children enrolled in CCS and they also report the most linguistically diverse network of child-serving ECM providers.
During interviews with ECM stakeholders, we heard many common themes about challenges with referral processes and contracting arrangements that have also been documented for adult populations. These implementation challenges were exacerbated for children and youth populations because of unclear and inconsistent population definitions and eligibility criteria for child/youth POFs, poor understanding of the interaction of the ECM benefit with other programs & systems that exist exclusively for children and youth, and lack of minimum qualifications for ECM providers to meet the complex needs of children and families. Based on our research of the first year of ECM implementation for children and youth POFs, we offer the following 10 observations summarized. For the full length observations, please download this document:
1
Children and youth populations are an ECM policy after-thought.
2
Reliable and robust networks of qualified ECM providers for children and youth do not exist (yet).
3
For current & potential ECM providers, contracting is a big challenge and MCP payment schemes are not sustainable.
4
There are many outstanding questions and challenges about the role Community Health Workers (CHWs) can play as ECM providers.
5
Administrative approvals and authorizations for ECM can delay access to care, or entirely block an opportunity to engage a child, youth, or family.
6
Some families of kids with medical complexity – especially in CCS Whole Child Model counties – are turned off from ECM because it introduces another care manager into their lives.
7
For the half of the children/youth involved in child welfare who are eligible for ECM, quality is a major concern.
8
Even with knowledge about the ECM benefit, referrals to ECM may simply not happen.
9
Nobody’s talking about dental care within the context of ECM for kids.
10
Accountability for ECM for children and youth is elusive.
Recommendations for Improving ECM
It is widely acknowledged that the roll out of the ECM benefit for kids has been slow, which is often the case when new benefits are launched. But more than a year into availability of the ECM benefit for child and youth populations, MCPs and CBOs are still working extremely hard to figure out ECM for kids, and at the same time DHCS is course-correcting the overall ECM policy through streamlining and standardizing. While the vision of ECM holds much promise for supporting children, youth, and families, there is much room for improvement in the actual implementation. To that end, we offer the following recommendations for DHCS and MCPs to improve the ECM benefit for children and youthbelow and [downloadable].
- Develop an action plan and schedule for streamlining and course-correcting around the ECM benefit policy for children and youth. Streamlining strategies should be developed that are specific to children and youth POFs, for example:
- Developing ECM assessments that are specifically tailored to child/youth populations;
- Clarifying the role of CHWs in delivering ECM for children/youth rather than describing CHWs as a separate workforce;
- Considering allowances for Whole Child Model CCS case managers to be ECM providers;
- Standardizing billing processes and reimbursements; and
- Addressing uncompensated long travel times for ECM services delivered in the community.
- Enforce compliance with MCPs’ ECM provider directories and perform an audit as it relates to ECM provider network robustness for all MCPs to ensure there are qualified providers available and willing to serve child and youth populations.
- Each provider directory should clearly differentiate between pediatric and adult-serving providers.
- Provider directories should have at least one qualified provider who serves CCS populations, and MCPs should build out provider networks if not.
- Track Closed Loop Referrals to ECM for children/youth and enforce compliance with ECM authorization timelines so that children and youth can access ECM services more quickly.
- Develop and vet comprehensive guidance and standards to hold MCPs accountable for:
- Timely action on ECM referrals involving child/youth members;
- Connecting child/youth members to an appropriately qualified ECM provider;
- Ensuring adequacy and quality control of ECM providers and measurement of consumer experience/satisfaction with ECM; and
- Supporting child/youth member ECM care plans, including access to dental care and filling gaps in service availability for Community Supports available to children and youth.
- More flexibly contract and engage with potential ECM providers serving children and youth populations – for example, on-the-street outreach and in-home billing requirements may not respect or reflect the care relationship families have with trusted providers, nor may it be needed given the level that some families are engaged in care. Focused in-person contracting convenings or workshops could also be a way to support potential ECM providers for children and youth, and better understand their concerns around issues like data-sharing and sustainability. ECM provider recruitment efforts should be targeted to meet the cultural and linguistic needs of children and caregivers eligible for ECM. MCPs should also reimburse ECM providers in a timely way that reflects the reality of delivering ECM services and the cost of outreach.
- Improve compliance with ECM provider directory requirements and improve directory usability with respect to accuracy and accessibility. All plans should have easily accessible, downloadable PDFs with populations of focus clearly spelled out and languages listed, not just search portals. For example, it should be easy to identify the ECM providers serving children in CCS and if they are accepting new clients.
- Improve timeliness of ECM authorizations for children and youth by tracking referrals, streamlining referral processes, increasing authorization staff, and/or expanding presumptive authorizations so that children and youth can access ECM services more quickly.
- Play a proactive role in ECM implementation by establishing regular meetings with providers, proactively connecting providers serving the same populations of focus, and assigning an MCP liaison to be a point of contact with providers.
- Construct local ECM child/youth referral networks by embarking on trust-building, educational “promo tours” about ECM for kids that intentionally educate and connect with child-serving providers who can refer members to ECM, including obvious and eager partners such as:
- Pediatric and other clinical training and residency programs;
- Head Start/Early Head Start sites;
- School nurses;
- Pediatric day health centers;
- Local oral health programs; and
- Local or regional pediatric/medical/dental societies.
- An MCP could also develop training curriculum and invest in a parent “ambassadors” program for ECM.
- Pediatric and other clinical training and residency programs;
Additional Resources about ECM
Success stories
The PATHways to Success initiative shares successful examples of CBOs providing ECM and Community Supports and the resources available to support them in providing Medi-Cal services.
Perspective
Making Medi-Cal Enhanced Care Management Work for Children and Youth
This blogpost offers some reflections and recommendations on Making Medi-Cal Enhanced Care Management work for Children and Youth (May 21, 2024)
Panel discussion
A panel sponsored by Family Voices of California highlights a parent’s initial experience with ECM and a discussion with stakeholders on the ECM landscape and a first look at data. (April 25, 2024)
News
How to Make it Easier for Kids with Disabilities to Get Care
A news article describes How to Make it Easier for Kids with Disabilities to Get Care, including closed loop referrals to meaningful Enhanced Care Management (March 15, 2024)
Report
CalAIM Perspectives: How to Improve Enrollment in Enhanced Care Management
A report offers early CalAIM Perspectives: How to Improve Enrollment in Enhanced Care Management (November 30, 2023)
Perspective
This blogpost heralds the ECM benefit for child/youth populations as Kids in Medi-Cal to get New Care Coordination Help (June 21, 2023)
Report
Key Findings and Recommendations for Implementation of CalAIM Services
The RAND research team’s in-depth exploration of the implementation of key CalAIM services showed that a trauma-informed approach based on trust and connection can allow these programs to succeed and improve patients’ lives (October 2024)
News
More California Kids with Disabilities Are Enrolled in a New Health Program, But Is It Helping?
This California Health Report article highlights community concerns about the Enhanced Care Management benefits’ reach and effectiveness for children and youth (November 7, 2024)
Report
This report, developed by Aurrera Health Group, provides an overview of the landscape of hubs throughout California, many of which are participating in Medi-Cal’s Enhanced Care Management and Community Supports through CalAIM, providing Medi-Cal community health worker or doula services, or both (October 2024)
Report
This report by RAND identified promising practices for implementation and sustainability of key CalAIM services, including: adult and pediatric ECM, the community health worker (CHW) benefit, and dyadic services (October 2024)