Identifying and enrolling members eligible for ECM and CS benefits

Identifying and enrolling the members eligible for Enhanced Care Management (ECM) and Community Supports (CS) benefits

ECM (enhanced care management) and Community Supports (CS) benefits are targeted to high-cost, high-need members who will gain the most from from the whole-person, interdisciplinary, community-based care management services. It is the responsibility of managed care organizations (MCOs) to identify the right members based on DHCS defined eligibility criteria and connect them to the right…

Managing community supports & enhanced care management benefits

Managing Community Supports (CS) and Enhanced Care Management (ECM) benefits

Letitia is a 40-year-old female with Type-2 diabetes and Asthma living in suburbs with her two small children. She is eligible for Medicaid due to her low income and is currently enrolled in a managed care plan. A few months ago, she injured her back and has trouble driving to work and working full-time. She…

Enhanced care management for supplemental benefits

Enhanced care management for supplemental benefits

With supplemental benefits, many Medicare Advantage (MA) plans are attempting to address both the medical and social risks. The supplemental benefits include health-related services such as vision, dental, and hearing as well as services to address SDoH such as transportation, meal delivery, structural home modifications, pest control, etc. Most supplemental benefits are offered to members…