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California Advancing & Innovating Medi-Cal (CalAIM)

New Medi-Cal program

The state Department of Health Care Services (DHCS) designed a new program to improve the health and wellbeing of Medi-Cal members beyond traditional medical services, make services work together better, and improve the quality of services. The program is called California Advancing and Innovating Medi-Cal (CalAIM). CalAIM includes a new benefit, Enhanced Care Management (ECM), and new services called Community Supports (CS). Gold Coast Health Plan (GCHP) started offering CalAIM benefits and services to members in January 2022.

Enhanced Care Management (ECM)

Enhanced Care Management (ECM) is a benefit that provides extra care coordination services to members with very complex needs. This new benefit can help members get the care they need to stay healthy. It can also coordinate the care they get from different providers involved in their care.

Members who qualify for ECM will have their own care team led by a care coordinator. This person will talk to members and their doctors, mental health providers, specialists, pharmacists, case managers, social services providers, and others to make sure everyone works together to get members the care they need. They can also help them find and apply for other services in their community.

Community Supports (CS)

Community Supports (CS) are services that eligible members may access to help with social and other problems, such as housing and food. CS can help members stay healthier and avoid more serious health problems, hospital stays, or emergency room visits.

GCHP offers these CS to eligible members who are homeless or at risk of being homeless and have certain health conditions:

  • Housing services to help find housing, navigate housing benefits, pay for some expenses when moving in (like deposits), and help staying in housing once moved in.
  • Recuperative care for continued medical care in a safe, clean place after a hospital stay.

Members who have Congestive Heart Failure and had a hospital stay may be eligible for healthy meals to keep from getting sicker or going back in the hospital.

Members who qualify may be contacted about ECM or CS services. Members can also call GCHP at 1-888-301-1228 or talk to their health care provider to find out if and when they can receive ECM or CS.

Participating in ECM or CS is voluntary. Members can decline these services if they decide they don’t want them.

Member resources

ECM letter

In December 2021, GCHP members were sent the following letter about the new ECM benefit:

Provider resources