ECM is designed to serve Medi-Cal members who face significant challenges in their health and daily lives. At CCHC, we focus on helping individuals who have difficulty accessing the care they need due to complex issues. We serve adults and children/youth in our community who fall into categories such as:

• People experiencing homelessness or housing instability who also have complex health conditions.

• Individuals with frequent hospitalizations or emergency room visits (“high utilizers”) due to chronic illnesses or other unmanaged health needs.

• Adults with serious mental illness or substance use disorders who need help coordinating behavioral health care with other services.

• People transitioning from jail or prison who have significant physical or mental health needs as they re-enter the community.

• Older adults and people with disabilities at risk of being placed in long-term care institutions (nursing facilities) – our support helps them remain safely in their homes whenever possible.

• Children and youth with complex medical or developmental conditions (such as those in California Children’s Services) who require coordinated care beyond regular medical services.

• Youth in foster care or involved in the child welfare system, including former foster youth up to age 26, who often need extra support during life transitions.

• Pregnant and postpartum individuals facing high health risks or disparities (for example, Black and Indigenous mothers who statistically experience higher rates of complications) – we provide enhanced care to improve maternal and infant health outcomes.

These focus areas align with the Populations of Focus defined by CalAIM for Enhanced Care Management . In other words, CCHC serves the groups that California’s Medicaid program has identified as most in need of intensive, whole-person care. If you or someone you know falls into any of these categories and is enrolled in Medi-Cal, ECM could be a life-changing resource. We encourage you to reach out or submit a referral so we can determine eligibility and begin helping. (Please see below for more details on each Population of Focus and specific eligibility criteria.)