Medi-Cal Programs

Enhanced Care Management services help to coordinate your care. You will have a Lead Care Manager who will work with your doctors, specialists, mental health providers, and other care staff to make sure everyone is working together to get you the care you need. A Lead Care Manager can also help you find services in your community that can help keep you healthy.

Enhanced Care Management services may include:

• Coordinating care based on your specific medical and social needs
• Helping you understand and manage medications
• Helping you schedule appointments
• Finding and applying for services in your community
• Working with you and your family to improve your health
  

Adults are eligible if:

• You and your family are homeless or don’t have a stable place to live
• You had 5 or more emergency visits, or 3 or more unplanned hospital and/or short-term skilled nursing facility (SNF) stays in the last 6 months
• You have a serious mental health condition or struggle with drug or alcohol use
• You are transitioning from incarceration
• You are at risk of entering a nursing home or facility
• You are staying in a nursing home or facility and need help to transition back to the community
• You are pregnant or had a baby in the last year and are Black, American Indian, Alaska Native, or Pacific Islander (as of 1/1/2024)

Children or youth under 21 are eligible if:

• You had 3 or more emergency visits, or 2 or more unplanned hospital and/or short-term SNF stays in the last 12 months
• You have a serious emotional or mental health condition or struggle with drug or alcohol use
• You are part of California Children’s Services (CCS) or Whole Child Model (WCM) and have additional social needs. This can include, but is not limited to food, stable housing, or transportation. Or you are having a mental health or substance use crisis. Or you had recent contact with police.
• You are in foster care now or have a history of being in a child welfare program or foster care
• You are transitioning from incarceration
• You are pregnant or had a baby in the last year and are Black, American Indian, Alaska Native, or Pacific Islander

A CHW is a non-licensed, trusted member of the local community with lived or shared experience to the people they support. You may know them as promotores, navigators or community health representatives.

Community Health Worker services help you meet your health goals and coordinate care. CHWs can help you with a range of needs including:

• Providing vetted information or instruction on health topics
• Coaching and goal setting to improve your health or ability to self-manage health conditions
• Accessing and understanding health care
• Connecting to community resources and services including medical translation/interpretation, transportation services, or health related social needs
• Having a cultural liaison
• Performing outreach and resource coordination around preventive services
• Helping with enrollment in government or other assistance programs
• Providing peer support.

Community Health Worker services do not include:

• Clinical case management or care management that requires a license
• Child care
• Chore services, including shopping and cooking meals
• Companion services
• Employment services
• Delivery of medication, medical equipment, or medical supplies.

You may be eligible for Community Health Worker services if you:

• Have one more chronic conditions (including mental health) OR exposure to violence and trauma
  and
• Have challenges in meeting your health or additional needs.

You cannot receive CHW services through this benefit if you are already enrolled in Enhanced Care Management (ECM). This program includes services that a CHW would provide.