Understanding Enhanced Care Management (ECM), Community Supports (CS), and Community Health Worker (CHW) Services
Table of Contents
Overview
Enhanced Care Management (ECM), Community Supports (CS), and Community Health Worker (CHW) services are three distinct Medi-Cal benefits created under California’s CalAIM initiative. Each one has its own purpose, eligibility, and provider requirements, but they are closely connected in practice.
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ECM is designed for members with complex health and social needs. It provides intensive, ongoing care management through a lead care manager and a care team.
- Community Health Workers often play an important role on ECM teams by building trust, helping with home visits, and keeping members connected to their care plan.
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CS are specific services that address health-related social needs, such as housing, food, or caregiver respite. They are offered by Managed Care Plans as cost-effective alternatives to higher-cost medical care.
- Community Health Workers often support members with Community Supports by helping with applications, connecting them to services, or following up to make sure the support is in place.
- CHW services are delivered by trusted community members who provide health education, navigation, assessments, and advocacy. This is a standalone benefit, but CHWs can also be integrated into ECM teams or help members access CS.
Together, these benefits form a stronger system of support. CHWs in particular play a unique role across all three: they deliver services through the CHW benefit, extend the reach of ECM teams, and help connect members to Community Supports. Understanding how each benefit works and how they intersect is key to making sure members receive the right care at the right time.
What is Enhanced Care Management (ECM)?
Enhanced Care Management, or ECM, is a Medi-Cal benefit for members with complex health and social needs. It goes beyond case management. ECM assigns a lead care manager who works directly with the member to create a whole-person care plan, then stays involved to make sure it is carried out.
Members who qualify often face multiple challenges at the same time. This can include:
- Living with multiple chronic health conditions like diabetes, heart disease, or asthma
- Experiencing serious mental illness or substance use needs
- Lacking stable housing or facing the risk of homelessness
- Transitioning from a hospital, nursing facility, or incarceration back into the community
- Children and youth with complex behavioral or developmental needs
What makes ECM different is the intensity of support. Care managers meet members where they are, which might be at home, in a shelter, or another community setting. Together they build a care plan that reflects the member’s priorities. The ECM team follows up regularly to coordinate appointments, link services, and adjust the plan as needs change.
What is a Managed Care Plan?
Medi-Cal services are delivered through Managed Care Plans, or MCPs. These are health plans contracted by the state to provide Medi-Cal benefits in each county. An organization that wants to provide ECM must contract with an MCP and be approved by the Department of Health Care Services (DHCS).
What are Community Supports (CS)?
Community Supports, sometimes called “In Lieu of Services” or ILOS, are Medi-Cal services designed to meet health-related social needs. They give members practical help in daily life so they can avoid higher cost care such as repeated emergency visits or long hospital stays.
Each Managed Care Plan decides which Community Supports it will offer in each county, so availability looks different depending on where you are.
Examples of Community Supports include:
- Housing navigation, deposits, and tenancy support
- Short-term post hospitalization housing
- Recuperative care for members who need a safe place to recover
- Medically supportive meals and groceries
- Home modifications such as ramps, grab bars, or air filters for asthma
- Respite services for caregivers
Unlike ECM, which provides ongoing care management, Community Supports are specific services tied to a social need. Some are time limited, such as transitional rent that covers up to six months, while others are focused on a health risk in the home, such as asthma remediation.
Do I need to be a contracted provider to offer Community Supports?
Yes. Community Supports are not a benefit that organizations can provide independently like reimbursement for CHW services under under Medi-Cal. To deliver them, you must contract with a Managed Care Plan, and you can only provide the services that plan has chosen to cover in your county.
What does “In Lieu of Services” mean?
“In Lieu of Services” refers to services that replace or prevent more expensive medical care. For example, providing short term housing after a hospital stay may prevent a costly readmission, making it a cost effective substitute for standard care.
What are Community Health Worker (CHW) Services?
Community Health Worker services are a standalone Medi-Cal benefit. Since July 2022, CHWs including promotores, representatives, and navigators have been able to bill Medi-Cal for their work when connected to the PAVE system.
Covered CHW services include:
- Health education
- Navigation support
- Screenings and assessments
- Individual advocacy
These services are billed in 30-minute units using CPT codes, with payment depending on whether the service is provided one-on-one or in a group setting. An organization must be tied to the PAVE system in order to bill Medi-Cal. Some organizations apply directly and become Supervising Providers themselves, while others work under a larger entity that manages enrollment and billing on their behalf. For example, a CHW organization may subcontract under Pear Suite, which serves as the Supervising Provider so CHWs can focus on supporting members.
CHW services are recognized as their own Medi-Cal benefit, which means CHWs can deliver covered services outside of ECM or Community Supports as long as they are tied to an enrolled Supervising Provider. In addition, CHWs are often part of ECM care teams and may also help members access Community Supports. This places CHWs in an important position across all three benefits, even though each benefit is distinct.
Billing Limits and Authorizations
When CHW services begin, each member automatically has 12 billable units (equal to 6 hours) pre-approved. After the first 12 units, the Supervising Provider must request authorization from the member’s Managed Care Plan for additional billable units.
APL 24-006 does not set statewide caps per claim, per month, or per year. However, it is important to understand that Managed Care Plans review requests for additional units and may set their own limits through the authorization process. At some point, if a member continues to need more units, the health plan may determine that the member requires a higher level of care. In those cases, the member may be transitioned into Enhanced Care Management (ECM). Once a member is receiving ECM, they are no longer eligible for CHW services as a standalone benefit.
For step-by-step instructions on how to submit a request for additional units in Pear Suite, see Requesting Additional CHW Billing for a Member.
What is the PAVE System?
The Provider Application and Validation for Enrollment, or PAVE system, is Medi-Cal’s online portal for provider enrollment. For CHW services, it is the organization that enrolls, not the individual CHW. Once approved, the organization becomes a Supervising Provider and can employ CHWs and bill Medi-Cal for their services. Smaller organizations that do not want to manage this process directly can instead work under another entity that is already enrolled in PAVE.
Where to Learn More
ECM, CS, and CHW services each have their own rules and provider requirements, but they are designed to work together. Understanding how they fit is the first step. The next step is knowing where to go for details that apply to your county or organization.
Here are some trusted places to start:
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ECM and Community Supports:
- Visit the DHCS CalAIM ECM & CS Resource Page for official guidance, provider information, and program updates.
- DHCS Enhanced Care Management Provider Toolkit.
- CALAIM Enhanced Care Management Policy Guide. Updated Aug. 2024
- Community Supports Availability: See the Community Supports Elections by MCP and County (Updated July 2025) to check which services are offered in your area.
- Community Health Worker Benefit: Visit the DHCS CHW Website for policy details, billing information, and provider enrollment resources.
- PAVE Enrollment: Access the PAVE system to learn how organizations apply to become Medi-Cal providers.
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Policy Updates – Review the most current All Plan Letters (APLs) for detailed requirements:
- DHCS All Plan Letter: APL 25-007 (July 2025) – Enhanced Care Management and Community Supports
- DHCS All Plan Letter: APL 24-006 (May 2024) – Community Health Worker Services Benefit
If your organization is just starting to explore these benefits, it can help to begin by identifying your role:
- Are you interested in becoming an ECM or CS provider?
- Do you want to deliver CHW services directly?
- Or would you benefit from partnering with an existing Supervising Provider or Managed Care Plan?
Answering these questions will help you decide which pathway makes the most sense and how best to support your community members.