Youth Enhanced Care Management Member Referral Form (age 20 and under)

Enhanced Care Management (ECM) is a no-cost benefit for eligible Medi-Cal members.

ECM helps children and youth with serious health, mental health or social challenges. This form helps us decide if the member may qualify. It does not mean you will get services.

Participation is your choice. Your information is private and only shared with staff helping with your care.

If you need help filling out 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).