Community Supports and Enhanced Care Management (ECM)

As a CalOptima Health member, you may qualify for California Advancing and Innovating Medi-Cal (CalAIM) Community Supports and Enhanced Care Management (ECM).

What Are Community Supports?

As part of California Advancing and Innovating Medi-Cal (CalAIM), Community Supports are services that can help you with more than just your basic health needs. You may qualify for Community Supports based on eligibility criteria. Services address:

Finding stable or safe housing
Accessing healthy food
Transitioning back to your home
Getting support in your home
And more

Community Supports Flyers and Referral Forms

Members and their families can learn more about and self-refer to Community Supports by accessing the flyers and forms below.

Community Support Flyers
Download the flyers to learn more about Community Supports.
Community Support Referral Form
You can also talk to your primary care provider, call us toll-free at 1-888-587-8088 (TTY 711) or refer yourself for Community Supports by filling out this form.
CalAIM Recuperative Care/Short-Term Post-Hospitalization Referral Form

What Community Supports are offered?

Housing Transition Navigation Services

Helps members to find housing including but not limited to conducting a housing assessment, developing a housing support plan, searching for housing and securing housing.

Housing Deposits

Helps members establish a basic household with funding for one-time costs, like a security deposit, setup fees/deposits for utilities, one-time cleaning, furniture and/or other goods.

Housing Tenancy and Sustaining Services

Helps members stay safe and stable in a home once they are housed. This can include education on the rights and responsibilities of the tenant and landlord, coaching on developing and maintaining a relationship with the landlord, and ongoing support with activities related to household management.

Recuperative Care (Medical Respite)

Provides members with short-term residential care when they need a safe place to heal from an injury or illness, but no longer need to be hospitalized.

Short-Term Post-Hospitalization Housing

Provides members who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical/ psychiatric/substance use disorder recovery immediately after exiting an inpatient hospital, residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care.

Day Habilitation Programs

Assists members in acquiring, retaining and improving self-help, socialization and adaptive skills necessary to reside successfully in the member’s natural environment.

Medically Tailored Meals

Provides members with medically tailored meals or groceries following discharge from a hospital or nursing home to meet their unique dietary needs.

Sobering Center

Offers an alternative for members who are found to be publicly intoxicated or otherwise under the influence of drugs, to enable them to avoid an unnecessary emergency department visit while still providing a medically safe place for them as the effects of the substance(s) wear off.

Home help provider assisting man with shaving

Personal Care and Homemaker Services

Assists members with activities of daily living, such as bathing or feeding, and instrumental activities of daily living, such as meal preparation or money management.

Home health provider discussing notes with patient

Respite Services

Provides services and support to caregivers of members to allow them to rest or take a break.

Environmental Accessibility Adaptions (Home Modifications)

Makes physical adaptations to a home environment that are necessary to ensure member health, welfare and safety, or enable members to function with greater independence in the home and avoid institutionalization.

Asthma Remediation

Makes physical modifications to a home environment that are necessary to ensure member health, welfare and safety, or enables members to function in the home and remediates acute asthma episodes that could result in the need for emergency services and hospitalization.

Home help provider talking with man on sofa

Nursing Facility Transition

Helps members transition out of nursing facilities and back into a home-like, community setting.

Community Transition Services

Allows members to live in the community and avoid further institutionalization.

Enhanced Care Management

Enhanced Care Management (ECM) is a new statewide Medi-Cal benefit available to select populations of focus that addresses the clinical and non-clinical needs of the highest-utilizing members through intensive coordination of health and health-related services. ECM meets members wherever they are—on the street, in a shelter, in their doctor's office or at home. Members have a single lead care manager who will coordinate care and services among the physical, behavioral, dental, developmental and social services delivery systems, making it easier for them to get the right care at the right time.

ECM Referral Form

Members and their families may self-refer to ECM by using the form below.

CalAIM ECM Referral Form

Populations of Focus

Individuals and families experiencing homelessness
Adults, youth and children who are high utilizers of avoidable emergency department, hospital or short-term skilled nursing facility services
Adults with serious mental illness or substance use disorder
Children and youth with serious emotional disturbance, identified to be at clinical high risk for psychosis or experiencing the first episode of psychosis
Adults and youth who are incarcerated and transitioning to the community
Adults at risk of institutionalization and eligible for long-term care
Adult nursing facility residents transitioning to the community
Children and youth enrolled in California Children’s Services (CCS) with needs beyond CCS
Children and youth involved in child welfare (including those with a history of involvement in welfare and foster care up to age 26)

Stopping ECM

Participation in ECM is voluntary. If you would like to stop ECM at any time, please let your ECM provider know or call CalOptima Health Customer Service at 888-587-8088 (TTY 711) Monday through Friday, from 8 a.m. to 5:30 p.m.

Changing ECM Provider and/or Lead Care Manager

If you would like to change ECM provider and/or Lead Care Manager at any time, please call CalOptima Health Customer Service at 888-587-8088 (TTY 711) Monday through Friday, from 8 a.m. to 5:30 p.m.