Enhanced Care Management
Enhanced Care Management is a Gold Coast Health Plan benefit that provides extra support for Medi-Cal members with complex health and social needs. Through this program, eligible members are connected with a care coordinator who helps bring their care team together, including doctors, specialists, mental health providers, pharmacists, case managers, and community resources.
Qualifying for Enhanced Care Management
Enhanced Care Management (ECM) eligibility is based on a person’s overall health, care coordination needs, and life circumstances — not just one diagnosis. Gold Coast Health Plan reviews each person’s situation to determine whether ECM is the right level of support, which may include needs related to physical health, mental health, substance use, pregnancy, housing, or other challenges that make care more complex.
A patient may qualify for ECM if they are experiencing one or more of the following:
- Complex physical health needs that make it difficult to manage care, appointments, medications, or services
- Serious mental health needs, including conditions that significantly affect daily life, relationships, work, school, or the ability to function
- Substance use disorder needs, including alcohol or drug-related conditions that require treatment or support
- A high risk of hospitalization, institutional care, overdose, or suicide
- Frequent emergency room visits, urgent care visits, hospital stays, or skilled nursing stays that may be avoidable with better care coordination
- Pregnancy or postpartum needs, especially when extra support is needed during pregnancy or in the year after delivery
- Homelessness or housing instability, including living in a shelter, temporarily staying with others, being at risk of losing housing, or leaving an institution without stable housing
- Difficulty with daily activities, communication, caregiving, safety at home, or living independently
This added support provided by ECM can help patients better understand their care plan, keep track of appointments and services, and connect with programs that support their overall health and well-being. The goal is to make care feel less overwhelming and help patients get the right support, in the right place, at the right time.
Patients who qualify may be contacted by Gold Coast Health Plan directly. To learn more, talk to your healthcare provider or call our Community Memorial Enhanced Care Management Coordinator at 805-948-4155.
