Provider Newsletter | Issue 27

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ECM/CS programs launched in Monterey and Santa Cruz

As of January 1, 2022, Enhanced Care Management (ECM) and Community Supports (CS) programs have kicked off in Monterey and Santa Cruz counties. ECM will be offered in Merced County in July 2022.

Introduced as part of CalAIM, ECM is a whole-person, interdisciplinary approach that addresses the clinical and nonclinical needs of high-risk Alliance members.

Who can receive ECM services?

Members who are currently eligible are:

  • Individuals and families experiencing homelessness.
  • Adults who are high utilizers.
  • Adults with SMI/SUD.

Eligibility will open to include more populations over the next 1 1/2 years.

Community Supports are optional, medically appropriate and cost-effective alternative services. The Alliance offers the following CS services:

  • Housing transition navigation services.
  • Housing deposits.
  • Housing tenancy and sustaining services.
  • Medically tailored meals.
  • Sobering centers (Monterey County only).


Who can receive CS services?

Members can be referred to CS by an ECM provider, primary doctor, social services providers and others. Members or their families may also ask for Community Supports.


Medi-Cal covers at-home COVID-19 tests obtained at pharmacies

Beginning Feb. 1, Medi-Cal will cover the cost of at-home COVID-19 tests for members. Federal Drug Administration (FDA)-authorized, self-administered COVID-19 antigen test kits can be billed and reimbursed as a pharmacy-billed medical supply benefit. Tests must be acquired from pharmacies that are enrolled as Medi-Cal providers. At-home COVID-19 tests are covered by Medi-Cal Rx, not the Alliance.

Please let your patients know that at-home COVID-19 test kits are now available to them at no cost. Alliance members will need to go to a pharmacy that is enrolled as a Medi-Cal provider. A pharmacist can write them a prescription to get a test kit at no cost.

Beneficiaries are limited to eight covered tests per month. However, more tests may be covered if they are ordered or administered by a provider after an individualized clinical assessment.

Guidance on the pharmacy billing process for tests is forthcoming from DHCS, and will be published prior to Feb. 1.

DHCS is also reimbursing beneficiaries for the retail cost of at-home COVID-19 test kits purchased between March 11, 2021 and January 31, 2022. More information on out-of-pocket expense reimbursements is available on the DHCS website.

Additionally, the federal government is mailing 4 free at-home COVID-19 test kits per U.S. household. Every home in the U.S. is eligible. To get these tests, individuals must request them online at www.covidtests.gov.

For more information on Medi-Cal Rx coverage of over-the-counter test kits, please view the full guidance on the DHCS website.