Kern Health Systems (KHS) offers the Enhanced Care Management (ECM) benefit for eligible Kern Family Health Care (KFHC) Members. These services help coordinate the Member's physical, behavioral, developmental, oral health, long term services and supports (LTSS), and services that address social determinants of health.
There is no cost to the member for ECM services.
If you would like more information or to find out if the KFHC Member qualifies please call us at 1.800.391.2000 or email us at ecmoutreachspecialist@khs-net.com. You or the eligible KHFC Member may also be contacted by KHS or our contracted ECM providers to see if they are interested in enrolling into an ECM Program.
Who is eligible for ECM?
KFHC Members may qualify for ECM if they are within one (1) or more of the following Populations of Focus. Members receiving hospice services and/or members receiving any type of care under a 1915(c) waiver do not qualify.
Adults (Age 21 and over):
Adults experiencing homelessness, such as:
- Lacking adequate nighttime residence
- Living in a shelter
- Imminently losing housing in next 30 days
- Victims fleeing domestic violence
- Part of a family experiencing homelessness
Adults who have been admitted to the hospital three (3) or more times in the past six (6) months or have visited the Emergency Department five (5) or more times in the past six (6) months
Adults with serious mental illness and or substance use disorder needs:
- Members who qualify are those receiving services through County Specialty Mental Health or Drug Medi-Cal and meets one (1) or more of the following:
- Uses the emergency department, urgent care, or inpatient hospital as sole source of care
- Is at high risk of hospital or skilled nursing facility admission, overdose, and/or suicide
- Had two (2) or more emergency department visits, or two (2) or more hospitalizations due to SMI or SUD in past 12 months
- Is pregnant or is less than 12 months post-partum
Adults who are transitioning from incarceration
- Members who qualify are those who transitioned from incarceration within the last 12 months and has at least one (1) of the following:
- Mental illness
- Substance use disorder
- Chronic disease
- Intellectual or developmental disability
- Traumatic brain injury
- HIV
- Pregnancy or Postpartum
Adults Living in the community and are at risk for long-term care institutionalization
- Members who qualify will have all of the following:
- Are living in the community who meet the SNF Level of Care (LOC) criteria; OR who require lower-acuity skilled nursing, such as time-limited and/or intermittent medical and nursing services, support, and/or equipment for prevention, diagnosis, or treatment of acute illness or injury;
- And are actively experiencing at least one complex social or environmental factor influencing their health (including, but not limited to, needing assistance with activities of daily living (ADLs), communication difficulties, access to food, access to stable housing, living alone, the need for conservatorship or guided decision-making, poor or inadequate caregiving which may appear as a lack of safety monitoring);
- And are able to reside continuously in the community with wraparound supports (i.e., some members may not be eligible because they have high-acuity needs or conditions that are not suitable for home-based care due to safety or other concerns).
Adult Nursing Facility Residents Transitioning to the Community
- Members who qualify will have all of the following:
- Are interested in moving out of the institution;
- And are likely candidates to do so successfully;
- And are able to reside continuously in the community.
Adult Birth Equity Population of Focus
- Adults who are pregnant or are postpartum, through 12 months, and are subject to racial and ethnic disparities as defined by California public health on maternal morbidity and mortality, including Black, American India, Alaska Native, and Pacific Islander individuals.
Children and Youth (age 20 and under):
Children and youth who are part of a Homeless Family or Unaccompanied Children/Youth Experiencing Homelessness.
Children and Youth who have been admitted two (2) or more times or have visited the Emergency Department three (3) or more times in the past twelve (12) months.
Children and Youth with serious mental health and/or substance use disorder needs:
- Members who qualify are those receiving services through County Specialty Mental Health or Drug Medi-Cal. No further criteria are required to be met for children and youth to qualify for this ECM population of focus.
Children and Youth transitioning from a youth correctional facility.
- Members who qualify are those who transitioned from incarceration within the last 12 months. No further criteria is required for children/youth.
Children and Youth enrolled in CCS (California Children’s Services) or CCS WCM (California Children’s Services Whole Child Model) with additional needs beyond the CCS condition
- Children and Youth who are enrolled in CCS or CCS WCM and
- Are experiencing at least one complex social factor influencing their health.
Children and Youth involved in Child Welfare
- Children and Youth who:
- Are under age 21 and are currently getting foster care in California;
- Are under age 21 and previously received foster care in any state in the last 12 months;
- Have aged out of foster care on or after their 18th birthday up to age 26;
- Are under age 18 and are eligible for and/or in California’s Adoption Assistance Program
- Are under age 18 and are currently receiving or have received services from California’s Family Maintenance program within the last 12 months.
Youth Birth Equity Population of Focus
- Youth who are pregnant or are postpartum, through 12 months, and are subject to racial and ethnic disparities as defined by California public health on maternal morbidity and mortality, including Balck, American Indian, Alaska Native, and Pacific Islander individuals.
What services does ECM provide?
ECM provides care coordination services led by a care team. The ECM care team will work together with the member's health care providers including their doctors, specialists, pharmacists, case managers, and others, to coordinate the needed care and services.
Members enrolled in ECM will receive services including:
- A Comprehensive Assessment and Care Management Plan
- Enhanced Coordination of Care
- Health Promotion Services
- Comprehensive Transitional Care
- Member and Family Supports
- Coordination and Referral to Community and Social Support Services
Resources
- Department of Health Care Services Enhanced Care Management.
- KFHC Enhanced Care Management Brochure (English/Spanish).
- Enhanced Care Management Population of Focus Listing.
Justice - Involved Liaison
Justice – Involved Liaison
Laurie Garcia
661.617.2612
Laurie.Garcia@khs-net.com