The Exodus Recovery CalAIM Program delivers Enhanced Care Management services and complementary Community Supports as a part of the state Medi-Cal CalAIM initiative.
What are CalAIM and ECM?
California Advancing and Innovating Medi-Cal (CalAIM) is a new program for eligible Medi-Cal members with complex medical and social needs who may benefit from enhanced care management and coordination.
Enhanced Care Management (ECM) is an essential component of CalAIM. ECM is a Medi-Cal managed care benefit that addresses clinical and non-clinical needs of eligible members through the coordination of services and comprehensive care management.
You may learn more about CalAIM by going directly to the Department of Health Care Services website.
The Exodus Recovery CalAIM Program works with your Medi-Cal health plan, providers, specialists, pharmacies, case managers, caregivers, and others, in order to help you get the care you need. You are assigned a Lead Care Manager who will help to coordinate your care and also acts as your advocate when you experience challenges obtaining needed services, making appointments, obtaining medical equipment, referrals, and much more. This combination of coordination and advocacy can help ensure that your providers are all staying informed on your care, and that all are working toward the same goal(s). By providing you with your own advocate, we strive to ensure that your voice is not lost, and that your needs are being met appropriately. If you have additional needs that impact your stability, your care team can also help in identifying resources within the community that might be of assistance. This wraparound approach aims to support your health, overall well-being, and self-care.
What services does Exodus CalAIM offer?
- Outreach and Engagement
- Comprehensive Assessment and Care Management Planning
- Enhanced Coordination of Care
- Health Promotion
- Comprehensive Transitional Care
- Member and Family Supports
- Coordination of and Referral to Community and Social Supports, including housing.
I already have insurance. Will this change my medical plan and doctors?
There will be no changes to your health plan and you can see the same doctors. This program is a benefit available to you on behalf of your current medical coverage. ECM simply offers you a care manager to assist you in collaborating and advocating with your doctors and other providers. You can still see your same doctors, but now you can get an added layer of support.
ECM is voluntary for members to receive. If you qualify, it is your choice whether you would like to receive the ECM benefit or not. Declining the ECM benefit will not affect any of you other Medi-Cal benefits.
Do I qualify?
CalAIM Enhanced Care Management (ECM) is intended for Medi-Cal managed care plan members with the most complex medical and social needs and in need of long-term help coordinating services across delivery systems to address their needs. Managed care plans are responsible for regularly identifying members who are eligible and may benefit from these services. In those cases, members may be contacted directly by their health plan and/or our program. Your health or social services providers may also submit referrals to your health plan. You can call your Medi-Cal plan directly to find out if you qualify for Enhanced Care Management services and self-refer. We can also help you talk to your health plan. You must be enrolled in a Medi-Cal health plan to access CalAIM services. If you need help enrolling into a Medi-Cal plan, you can call Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077).
I already have a Case Manager or receive similar services from another program. Do I still qualify?
Members may receive services from more than one program, including CalAIM Enhanced Care Management (ECM). In many of these scenarios, ECM will serve as a “wrap” and help fill gaps and coordinate across case management services available in other programs, however, there are some instances where members cannot be enrolled in ECM at the same time as other programs. Members with Cal-MediConnect do not qualify for ECM. Your Medi-Cal health plan can help you determine which programs are available to you and which will best address your needs.
How much does this service cost?
There is no cost to you. This service is provided to you at no out-of-pocket cost because it is a benefit offered by your medical insurance. Extra services at no cost may include the following:
- Finding doctors and making appointments
- Understanding your prescription drugs
- Setting up transportation to your doctor visits
- Getting follow-up services after you leave the hospital
- Connecting to and applying for community programs and services, including food benefits or in-home help
I have too many appointments already. What if I’m just too busy?
CalAIM does not require a significant time commitment from you. Your care manager will ask to meet with you on a monthly basis. If you have many needs and would like to meet with your care manager more frequently, additional contacts may be scheduled. In-person visits may take place in the primary care setting, in hospitals, or emergency departments, in the community or in your home. Aside from that, your care manager will be checking in with you via monthly phone calls. In fact, CalAIM can often prove helpful in reducing your overwhelming obligations by taking on some of those urgent tasks so that you may feel less burdened. We are here to help.
I’m always getting calls from people claiming they are calling on behalf of my insurance. How do I know this is not a scam?
If you received a call from a care team member to offer information regarding CalAIM, you have already been referred by your medical plan. You may call your plan directly to inquire about CalAIM services and the reason why you were referred.
Exodus Recovery, Inc. is currently partnering in San Diego County with Blue Shield Promise, Community Health Group, Health Net, Molina Health Care of California, and United Health Care.
I’m interested. What do I do to sign up?
When a CalAIM Care Manager contacts you, inform them that you are interested in enrolling. The care manager will schedule a time to meet (at a location most convenient to you) in order to complete your intake and enroll you into the program.
You may also call your health plan directly to inquire about CalAIM.
I have questions. How do I contact you?You may contact the Exodus Recovery, CalAIM Program in San Diego County by calling