Enhanced Care Management vs. Community Supports: Why the Difference Matters

What Enhanced Care Management does

ECM gives eligible members a lead care manager who can coordinate across medical, behavioral, social and long-term-services systems. The work can include outreach, a comprehensive assessment, a care plan, coordination with providers and help during transitions.

Think of ECM as an ongoing coordination relationship. It is especially relevant when a person has several systems involved, frequent transitions or needs that are difficult to manage through isolated appointments. Eligibility is tied to DHCS populations of focus and the plan’s review.

What Community Supports do

Community Supports are defined services. Assisted Living Facility Transitions is one example. Other Community Supports address needs such as medically supportive food, recuperative care, personal care and homemaker services, or help moving from an institution to a private home. The exact services offered and the provider network can vary by plan and county.

A Community Support authorization should identify the service, the approved scope and the responsible provider. It does not automatically create a broad care-management relationship around every other need.

How the two can work together

A member might receive ECM while a care manager coordinates an Assisted Living Facility Transition. The ECM provider could help connect the hospital, plan, family and receiving setting, while the Community Support funds the authorized transition or assisted living service.

Another member may receive the assisted living transition service without ECM. In that case, the plan or contracted Community Supports provider still needs a clear way to coordinate the service. Families should ask who is acting as the day-to-day point person instead of assuming “CalAIM” names a single team.

• Ask whether the member is already enrolled in ECM and who the lead care manager is.
• Ask which Community Support is being requested and who will submit it.
• Clarify who will communicate the authorization decision and who will coordinate the move.

Common mix-ups that slow a referral

A referral can drift when every participant assumes another program owns the next step. One team may be waiting for an ECM assignment while the family believes the facility has already asked for the Community Support. Another common problem is using “care coordination” as a catch-all phrase without naming the benefit or authorization requested.

Use exact language in emails and meeting notes. “ECM eligibility review,” “Assisted Living Facility Transitions referral” and “RCFE admission review” are three different actions. Labeling them separately makes gaps visible.

Questions to take to the health plan

Ask whether ECM and the desired Community Support are offered for the member, whether separate referrals are required, what information is missing and how the plan will notify the member of each decision. If the plan does not authorize a requested service, ask for the written notice and the instructions for a grievance or appeal.

For a broader view of the assisted living pathway, read Zeal’s family guide to CalAIM transitions.