Enhanced Care Management in Santa Clara County

A directory listing, not an eligibility decision.

UniHealth can identify a possible match, but the responsible program makes the final decision.

What to know

Why it may fit: Your circumstances can be checked against the program’s published guidelines.
What to do next: Enhanced Care Management (ECM) gives you one lead care manager. That person helps coordinate your health care and social services. It is a Medi-Cal health plan benefit for people with complex needs.
Who runs it: Medi-Cal managed care plan

What the program may consider

You are in a Medi-Cal managed-care plan
You meet a 2026 ECM Population of Focus definition
You need coordinated physical, behavioral or social services
You are not enrolled in a D-SNP, PACE, MSSP, HCBA, the Assisted Living Waiver or California Community Transitions (if you are only on a waiver waitlist, you can use ECM in the meantime)

How to get it

Enhanced Care Management (ECM) gives you one lead care manager. That person helps coordinate your health care and social services. It is a Medi-Cal health plan benefit for people with complex needs.

Before you start

You need this first Aged, Blind and Disabled Federal Poverty Level Medi-Cal. You need Medi-Cal, and you must be in a Medi-Cal health plan.

How to apply

Enhanced Care Management referral

Medi-Cal health plans accept this standard form. Send it to the person's own plan. The person can also just call the plan.

PhoneSanta Clara Family Health Plan Medi-Cal member services: 1-800-260-2055Members can call to ask for these services.

You can also use: Sourcewise care management referral

One referral for MSSP and Sourcewise's other care management. Anyone can make it, with the person's OK.

Getting help

Someone can refer you, with your permission

You or your family can call your health plan and ask for ECM. A doctor or community group can also refer you, with your OK. You do not sign the referral. The ECM provider will ask if you want to join.

What happens after you apply

Your plan gets the referral. It can come from you, your family, a doctor or a community group.
Your health plan
Your plan checks if you are in a group ECM serves, then decides. You get a letter within 2 business days after the decision.
Your health planWithin 5 working days. If it is urgent, within 3 days.
Your plan assigns an ECM provider. That provider gives you a lead care manager.
Your health plan
The ECM provider contacts you. You say yes if you want ECM. If they cannot reach you, the referral may close.
The program or providerA helper can help with this
Your care manager meets you, learns your needs, and makes a care plan with you.
The program or providerOnly you can do this

What only you can do

Say yes when the ECM provider contacts you.
Take part in the needs check and the care plan.
Keep your phone number and address up to date so they can reach you.

How long it takes: About 1 to 4 weeks.
You are enrolled when: You are enrolled when your plan approves ECM, you agree, and your care manager starts working with you.
To keep it: Your plan first approves ECM for 12 months. After that, it reviews every 6 months. Stay in the same Medi-Cal plan, and renew Medi-Cal each year. Keep working with your care manager.

Can’t be combined with

Dual Eligible Special Needs Plan (D-SNP / Medi-Medi). Some people have a Medicare plan made for people with both Medicare and Medi-Cal. They get care management from that plan instead of ECM. Choosing a plan is your own choice. HICAP gives free, unbiased help.
Program of All-Inclusive Care for the Elderly (PACE). PACE members get care coordination from PACE, not ECM.
Multipurpose Senior Services Program (MSSP). You cannot get ECM and MSSP at the same time. You choose one.
Home and Community-Based Alternatives (HCBA) Waiver. You cannot get ECM while in the HCBA waiver. ECM can help while you are on the waitlist. When a spot opens, you choose one.
Assisted Living Waiver (ALW). You cannot get ECM while in the Assisted Living Waiver. ECM can help while you are on the waitlist. When a spot opens, you choose one.
California Community Transitions. You can be in ECM or California Community Transitions, but not both at the same time.

Coming changes

Starting January 1, 2027: Starting January 1, 2027, some adults under 65 must renew Medi-Cal every 6 months. If your Medi-Cal stops, ECM stops too.
Starting January 1, 2027: Starting January 1, 2027, people without a qualifying immigration status leave Medi-Cal health plans. They can no longer get ECM through a plan.