Last updated: November 2026
Enhanced care management (ECM) is the California Medi-Cal benefit for members with the most complex medical and social needs, delivered by community-based providers under contracts with Medi-Cal managed care plans. ECM provider readiness is the written program, evidence file and mock review IHS prepares so an organization can show a plan it meets the guide's requirements. Integral Healthcare Solutions (IHS) is a consulting firm. It drafts those documents for your clinicians to approve, and your organization contracts with the plans and delivers the service.
This is program development, one of three IHS practice lines with accreditation consulting and compliance services. It is not legal or clinical advice.
What is CalAIM enhanced care management?
The California Department of Health Care Services (DHCS) describes ECM as “a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of Members with the most complex medical and social needs.” Source: CalAIM Enhanced Care Management Policy Guide, Updated September 2026 (page opened November 5, 2026), our governing text.
The guide is written for the plans. It says it is a resource for Medi-Cal managed care plans (MCPs) implementing ECM, and that their duty to implement ECM comes from its MCP contract, All Plan Letter 21-012 or the letter that replaces it, and DHCS's ECM and Community Supports Standard Provider Terms and Conditions. We read the guide, not any plan contract, all plan letter or the standard terms, so your plan's contract controls wherever it differs from this page.
A member must be enrolled in a Medi-Cal managed care plan and meet at least one of nine populations of focus. They include people experiencing homelessness, people with serious mental health or substance use disorder needs, people transitioning from incarceration, children and youth involved in child welfare, and the birth equity population.
The DHCS ECM page (opened November 5, 2026) reports 276,558 members who received ECM and 4,615 contracted ECM providers from Q2 2024 to Q2 2025. The provider figure counts contracts: each unique combination of national provider identifier, provider type, plan and county is one, so an organization that contracts with several plans in the same county may be counted more than once.
Who can be an ECM provider, and what do plans check?
A wide range of organizations can. The guide lists counties, physician groups, federally qualified health centers, community-based organizations, hospitals and local health departments, among others, and says the list is not limited to those. Prior experience serving Medi-Cal plan members is not required, and each plan decides what counts as sufficient experience.
We group the guide's requirements into four checks:
- Capacity. A provider must have the capacity for culturally appropriate and timely in-person care management, and must be able to communicate with members in a culturally and linguistically appropriate and accessible way.
- Enrollment. A provider must enroll as a Medi-Cal provider only if a state-level enrollment pathway exists for it. The guide says for-profit organizations delivering only ECM and Community Supports generally have none, and that providers serving the justice-involved population must be Medi-Cal enrolled.
- Credentialing. Plans do the screening, enrollment, revalidation, credentialing and recredentialing under 42 CFR Part 455, the guide, the plan contract and All Plan Letter 22-013 or a superseding letter. As the guide describes that letter, plans revalidate enrollment at least every five years, with an exception for providers already enrolled through DHCS or another plan within the required timeframes, and verify credentials every three years. A plan that screens and enrolls its own providers must give a written determination within 120 calendar days of receiving the application, per All Plan Letter 22-013 (July 2022; page opened November 5, 2026). DHCS does not set licensing requirements for ECM care managers.
- Plan criteria. The guide says plans may consider, among other things, whether the provider can receive referrals, has sufficient experience, can submit claims or invoices by standard protocols, can meet reporting and oversight requirements, and has any history of fraud, waste or abuse. It also says plans should consider national accreditation or certification standards.
The guide says contract Section 3.h bars a plan from requiring an eligible ECM provider to be NCQA certified or accredited as a condition of contracting, and that plans may not use NCQA tools to oversee ECM providers unless the provider agrees. If the plan delegates complex care management functions to its ECM providers, those providers are subject to pre-delegation review.
What must an ECM provider be able to deliver?
All seven core services. The guide says the provider is expected to provide all of the services as enumerated and not only a subset. They are outreach and engagement; comprehensive assessment and care management plan; enhanced coordination of care; health promotion; comprehensive transitional care; member and family supports; and coordination of and referral to community and social support services.
- The care plan must cover physical health, mental health, substance use disorder, community-based long-term services and supports, oral health, palliative care, social supports and social drivers of health, and be updated under appropriate clinical oversight. There is no annual reassessment requirement. Members are reassessed at a clinically appropriate frequency.
- For transitional care, plans must ensure providers have access to admission, discharge and transfer feed data. Plans provide it within 24 hours of the event where a feed is available, unless the plan has verified the provider already has access through another source.
- Each member needs a dedicated lead care manager. The guide sets no required staffing ratio at this time.
- The provider needs a care management documentation system or process that integrates physical, behavioral, social service and administrative information. A plan may not require use of its portal for documentation.
- A September 2026 addition says service delivery expectations emphasize an average of three or more encounters per month, while the appropriate intensity may vary by population of focus and member needs.
How are ECM providers paid and overseen?
Payment follows the contract between the plan and the provider, and DHCS does not specify the payment model. The guide says plans are expected to reimburse outreach, including unsuccessful outreach, and that a provider without encounter capability must be allowed to submit invoices. The guide states that the Medi-Cal managed care boilerplate contract requires plans to pay 90% of clean claims within 30 days of receipt and 99% within 90 days.
Oversight runs through the plan, which must hold providers to the same reporting requirements it reports to DHCS and require claims on the DHCS code sets. A provider must notify the plan to discontinue ECM when the member has met all care plan goals, is ready for a lower level of care, no longer wants ECM or will not engage, or cannot be reached after multiple attempts. The guide treats continuing ECM after that point as raising fraud, waste and abuse.
How IHS helps
IHS prepares the documents and the rehearsal, and your organization makes every decision and every submission.
What IHS drafts
- A readiness review against the guide, with an evidence map tying each requirement to a document in your files.
- Policies and procedures for each core service, discontinuation, documentation and data sharing, with clinical content written for your clinicians to approve.
- A mock chart review against the seven core services, with findings and drafted corrections.
What you supply
You supply the plan contracts, your enrollment status, the populations of focus you will serve, your care manager roster and credentials, your documentation system, and clinical sign-off on every clinical policy.
The real limit
IHS does not decide whether a plan will contract with you or on what terms. IHS does not submit your materials and does not contact DHCS or a plan for you. Your organization handles all of that.
What to have ready
These items follow sections of the CalAIM Enhanced Care Management Policy Guide, Updated September 2026.
- The populations of focus you will serve (Section IV).
- A policy for each of the seven core services, covering all seven (Section V).
- Outreach procedures that record each attempt and modality (Section V.1).
- A care plan template covering every need area the guide lists, with a clinical review step (Section V.2).
- A transitional care procedure and a way to receive admission, discharge and transfer data (Sections V.5 and IX).
- Your lead care manager assignments and role description (Section VIII.J.3).
- Your care management documentation system (Section VII.D).
- Your Medi-Cal enrollment status or a statement that no state-level pathway exists for you, plus the credentialing records your plan asks for (Section VII.C).
- A discontinuation procedure that tracks the four circumstances (Section VIII.K), and your claims or invoice process (Sections VII.E and XI.B).
To compare your documents with this list, schedule the free introductory call below.
How it compares
ECM is one part of CalAIM, and the guide says ECM and Community Supports are separate initiatives. Enrollment as a Medi-Cal provider is a separate subject, covered on our Medicaid provider enrollment and revalidation page. A plan building its own model of care has a different task, and New York's social care network program is a different state program. Your leadership, the plans and your counsel decide which route fits.
What it costs
The guide names no fee for becoming an ECM provider, and it says DHCS is not specifying the payment model between plans and providers. Payment terms are in each plan contract, so confirm them with each plan. IHS scopes each engagement after a free introductory call.
What this is not
- It is not legal advice. IHS is a consulting firm, not a law firm.
- It is not a guarantee that a plan will contract with you. The plan decides.
- It is not submission or liaison work. IHS does not submit to DHCS or a plan and does not contact them for you.
Frequently asked questions
What is CalAIM enhanced care management?
DHCS describes it as a whole-person, interdisciplinary approach to care for members with the most complex medical and social needs. Community-based providers deliver it under contracts with Medi-Cal managed care plans.
Who can become an ECM provider?
The guide lists counties, health centers, physician groups, hospitals and community-based organizations, among others, and says the list is not limited to those. Prior experience serving Medi-Cal plan members is not required. Each plan decides what counts as sufficient experience.
How does an organization become an ECM provider?
It contracts with a Medi-Cal managed care plan, and the plan screens, enrolls and credentials it. Where a provider has no state-level enrollment pathway, the guide says each plan must create and implement its own process. Ask each plan for it.
Does an ECM provider need NCQA accreditation?
Not under the guide. It says contract Section 3.h bars a plan from requiring eligible ECM providers to be NCQA certified or accredited as a condition of contracting. If a plan delegates complex care management functions to ECM providers, they are subject to pre-delegation review.
What must an ECM provider show it can do?
All seven core services, and not only a subset. It also needs a care management documentation system and a dedicated lead care manager for each member.
How are ECM providers paid?
Under the contract between the provider and the plan. DHCS does not specify the payment model. Plans are expected to reimburse outreach, including unsuccessful outreach, and a provider without encounter capability must be allowed to submit invoices.
How is ECM different from Community Supports?
The guide calls them separate initiatives. Some members qualify for only one of them.
When does ECM end for a member?
A provider must notify the plan to discontinue ECM when the member has met all care plan goals, is ready for a lower level of care, no longer wants ECM or will not engage, or cannot be reached after multiple attempts. The guide treats continuing ECM after that point as raising fraud, waste and abuse.