Adult Enhanced Care Management Member Referral Form (age 21 and over)

Enhanced Care Management (ECM) is a no-cost benefit for eligible Medi-Cal members. ECM helps people with serious health, mental health needs or social challenges.

This form helps us decide if you qualify for ECM. It does not mean you will get ECM services. Participation is your choice. Your information is private and only shared with staff helping with your care.

If you need help finishing this form, call us at 800-700-3874.

We offer no-cost help in your language. Call 800-700-3874 (TTY: 800-735-2929 or 711).