Description: Provides case management for Medi-Cal enrollees with complex needs. Enrollees are assigned a Lead Care Manager who will work with their doctors, specialists, mental health providers, and other care staff to ensure necessary care is provided.Enhanced Care Management services may include:Coordinating care based on the individual's specific medical and social needsHelping individuals understand and manage medicationsHelping individuals schedule appointmentsFinding and applying for services in the individual's communityWorking with individuals and their families to improve their healthThe program is supported by CalAIM, also known as the Medi-Cal Transformation Initiatives. To learn more about CalAIM, click here.
Eligibility: To be eligible, an individual/family must meet the following eligibility requirements:- Enrolled in Medi-Cal with Partnership, Molina Healthcare California, CalViva Health, Anthem BCBS, Contra Costa Health Plan, or ILS (Kaiser).- Live in a county within the service area.Adults are eligible if they:- Are homeless or don't have a stable place to live- Are at risk for avoidable hospital or emergency department care.- Have a serious mental health condition or struggle with drug or alcohol use- Are transitioning from incarceration- Are at risk of entering a nursing home or facility- Are staying in a nursing home or facility and need help to transition back to the community- Are pregnant or had a baby in the last year and are Black, American Indian, Alaska Native, or Pacific IslanderChildren, or youth under 21, are eligible if they:- Are homeless or don't have a stable place to live- Are at risk for avoidable hospital or emergency department care.- Have a serious emotional or mental health condition or struggle with drug or alcohol use- 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 they are having a mental health or substance use crisis, or have had recent contact with police.- Are in foster care now or have a history of being in a child welfare program or foster care- Are transitioning from incarceration- Are pregnant or had a baby in the last year and are Black, American Indian, Alaska Native, or Pacific Islander
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