Medi-Cal Programs

Enhanced Care Management services help to coordinate your care. You will have a Lead Care Manager who will work with your care teams. This includes doctors, specialists, and mental health providers.  They make sure everyone is working together and you get the care you need. A Lead Care Manager can also help you find services near you to help you stay healthy.

Enhanced Care Management services may include:

• Coordinating care based on your specific medical and social needs
• Helping you manage your medications
• Helping you schedule appointments
• Finding and applying for services near you
• Helping you and your family improve your health

Adults are eligible if: 1

• 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
• You are staying in a nursing home 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

Children or youth under 21 are eligible if: 1

• 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 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 more social needs. This can include food, stable housing, transportation, or other needs. 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

^{1 Members may not be enrolled in ECM and any of the following programs at the same time: Hospice, Program for All-Inclusive Care for the Elderly (PACE), Complex Care Management (CCM), California Community Transitions (CCT), and 1915 (c) Home and Community-Based Services Waiver (HCBS) -- including Medi-Cal Waiver Program (HIV/AIDS), Home and Community-Based Alternatives (HCBA), Assisted Living Waiver (ALW), Home and Community-Based Services Waiver for the Developmentally Disabled (HCBS-DD), Multipurpose Senior Services Program (MSSP), and Self-Determination Program (ICF-DD).}

Community Supports are services that help with social factors that affect your health. These services help you in your community. They may help you find housing and other non-medical services.

Eligibility depends on the type of Community Support. You don’t have to be enrolled in Enhanced Care Management to receive Community Supports.

Kaiser Permanente offers Community Health Worker (CHW) services at no cost to Medi-Cal members who qualify. A CHW is a non-clinical health professional. This means they are not a doctor, nurse, or social worker. They are a trusted member of your community who can help guide you through the healthcare system. They can offer you the support you need to reach your health goals. You may also know them as promotores, navigators or community health representatives. 

CHWs provide a wide range of support services. Here are some examples of how they can help you:

• Provide cultural or language support to understand your healthcare options
• Share information about your health condition
• Guide you to government programs and local resources, like food or transportation
• Go with you to doctor’s appointments
• Support you with issues related to domestic or community violence

Community Health Worker services do not include:

• Clinical services or other services that require a license
• Childcare
• Chores, such as shopping, cooking, or driving
• Socializing or companion services
• Employment services
• Delivery of medication, medical equipment, or medical supplies

Most Medi-Cal members may qualify for CHW services. If you need non-clinical support to reach your health goals, you may qualify.

You are not eligible to receive CHW services if you are enrolled in Enhanced Care Management.