Enhanced Care Management
Santa Clara Family Plan (SCFHP) is launching a new Medi-Cal benefit called Enhanced Care Management (ECM). ECM provides extra services at no cost to Medi-Cal members who qualify under one of the ECM Populations of Focus.
ECM offers SCFHP members:
|Assessment & Care Management||Care Coordination||Health Promotion|
|Develop and update a Health Action Plan (HAP) to guide services and care||Coordinate care across ALL providers||Educate members about and support them in adopting healthy behaviors|
|Transitional Care||Member and Family Support||Referrals to Community and Social Support Services|
|Facilitate care transitions between the hospital, nursing homes, other treatment facilities, and home||Support the self-management and decision making efforts of members and their family and/or support team||Connect members to community and social services, as needed|
Whole Person Care and Health Homes Program Transition to ECM
Effective January 1, 2022, SCFHP members enrolled in HHP will automatically transition to ECM. Eligible members enrolled in the County’s WPC program will also transition to ECM. SCFHP intends on reassigning members to the same provider for ECM that provided services under WPC or HHP. Members will receive notifications by mail about the transition. However, the transition should be seamless to members and there will not be any disruption in services during the transition.
ECM Providers and Lead Care Manager
SCFHP identifies members who are eligible for ECM and assigns them to ECM providers. ECM providers conduct outreach to assigned SCFHP members, engage them into enrolling into ECM, and deliver ECM services.
The Lead Care Manager oversees the delivery of ECM services and can help SCFHP members:
- Enroll in ECM
- Find doctors and schedule appointments
- Better understand their prescription drugs
- Set up transportation to doctor visits
- Receive follow-up services after a member leaves the hospital
- Find and apply for food benefits and housing
- Connect to other community programs and services
SCFHP will follow the following DHCS guidelines and implementation timelines for the Populations of Focus:
Starting January 1, 2022:
- Members enrolled in Health Homes Program (HHP) and Whole Person Care (WPC) will transition to ECM
- Population of Focus #1: Individuals and families experiencing homelessness;
- Population of Focus #2: High Utilizer Adults; and
- Population of Focus # 3: Adults with SMI/SUD.
Starting January 1, 2023:
- Population of Focus #4: Individuals transitioning from incarceration (adults and children/youth);
- Population of Focus #5: Members eligible for LTC and at risk of institutionalization; and
- Population of Focus #6: Nursing home residents transitioning to the community.
Starting July 1, 2023:
- Population of Focus #7: All other children and youth populations
How do eligible Medi-Cal members join ECM?
- Most eligible members will be contacted about ECM. SCFHP will identify members who are eligible for ECM and those members will receive a notice from SCFHP about their eligibility. SCFHP will also share the Member Information File (MIF) with contracted ECM providers so they can do their own outreach to the members.
- A provider submits a referral form for a member. If a member is not on the MIF but may be eligible for ECM, the provider can submit a referral form to SCFHP for enrollment in ECM. This may be necessary if the individual is newly enrolled in Medi-Cal.
- A member asks to join. Individuals can contact SCFHP Customer Service at
1-800-260-2055 (TTY: 711) and ask if they qualify for ECM.