California Medicaid To Launch Statewide Enhanced Care Management Referral Standards In January 2025 To Streamline Access

The California Department of Health Care Services (DHCS) is launching statewide referral standards starting January 1, 2025, for Medicaid Enhanced Care Management (ECM) services for high need individuals. In guidance released September 3, 2024, DHCS seeks to streamline ECM referrals made to Medi-Cal (the state’s Medicaid program) managed care plans (MCPs) from provider organizations, community-based organizations, and other entities. DHCS directed MCPs to expand the use of presumptive authorization with select ECM provider organizations to streamline the initiation of ECM for some members.

ECM providers with presumptive authorization arrangements will include an ECM Benefit Start Date to . . .